title: A decision model to estimate the cost-effectiveness of intensity modulated radiation therapy (IMRT) compared to three dimensional conformal radiation therapy (3DCRT) in patients receiving radiotherapy to the prostate bed.
abstract: BACKGROUND
  Intensity modulated radiation therapy (IMRT) is a radiation therapy technology that facilitates the delivery of an improved dose distribution with less dose to surrounding critical structures. This study estimates the longer term effectiveness and cost-effectiveness of IMRT in patients post radical prostatectomy.
  
  
  METHODS
  A Markov decision model was developed to calculate the incremental quality adjusted life years (QALYs) and costs of IMRT compared with three dimensional conformal radiation therapy (3DCRT). Costs were estimated from the perspective of the Australian health care system.
  
  
  RESULTS
  IMRT was both more effective and less costly than 3DCRT over 20 years, with an additional 20 QALYs gained and over $1.1 million saved per 1000 patients treated. This result was robust to plausible levels of uncertainty.
  
  
  CONCLUSIONS
  IMRT was estimated to have a modest long term advantage over 3DCRT in terms of both improved effectiveness and reduced cost. This result was reliant on clinical judgement and interpretation of the existing literature, but provides quantitative guidance on the cost effectiveness of IMRT whilst long term trial evidence is awaited.
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia. Electronic address: hannah.carter@ctc.usyd.edu.au.
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Carter
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Martin
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schofield
authors.affiliation: Sir Peter MacCallum Dept of Oncology, University of Melbourne, Australia.
authors.forename: Gillian
authors.initials: G
authors.lastname: Duchesne
authors.affiliation: Sir Peter MacCallum Dept of Oncology, University of Melbourne, Australia; Dept Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: Haworth
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, Australia.
authors.forename: Colin
authors.initials: C
authors.lastname: Hornby
authors.affiliation: Liverpool Cancer Therapy Centre, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Sidhom
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Jackson
mesh_terms: D001315:Australia; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D008390:Markov Chains; D011467:Prostate; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D019057:Quality-Adjusted Life Years; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000191:economics* / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics* / Q000379:methods
keywords: Cost; Decision model; Effectiveness; IMRT; Prostate cancer; Prostatectomy