title: Spacers in radiotherapy treatment of prostate cancer: is reduction of toxicity cost-effective?
abstract: OBJECTIVE
  To compare the cost-effectiveness of treating prostate cancer patients with intensity-modulated radiation therapy and a spacer (IMRT+S) versus IMRT-only without a spacer (IMRT-O).
  
  
  METHODS
  A decision-analytic Markov model was constructed to examine the effect of late rectal toxicity and compare the costs and quality-adjusted Life Years (QALYs) of IMRT-O and IMRT+S. The main assumption of this modeling study was that disease progression, genito-urinary toxicity and survival were equal for both comparators.
  
  
  RESULTS
  For all patients, IMRT+S revealed a lower toxicity than IMRT-O. Treatment follow-up and toxicity costs for IMRT-O and IMRT+S amounted to €1604 and €1444, respectively, thus saving €160 on the complication costs at an extra charge of €1700 for the spacer in IMRT+S. The QALYs yielded for IMRT-O and IMRT+S were 3.542 and 3.570, respectively. This results in an incremental cost-effectiveness ratio (ICER) of €55,880 per QALY gained. For a ceiling ratio of €80,000, IMRT+S had a 77% probability of being cost-effective.
  
  
  CONCLUSIONS
  IMRT+S is cost-effective compared to IMRT-O based on its potential to reduce radiotherapy-related toxicity.
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, The Netherlands. Electronic address: ben.vanneste@maastro.nl.
authors.forename: Ben G L
authors.initials: BG
authors.lastname: Vanneste
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, The Netherlands; Health insurance company CZ, Tilburg, The Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: Pijls-Johannesma
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, The Netherlands.
authors.forename: Lien
authors.initials: L
authors.lastname: Van De Voorde
authors.affiliation: Westdeutsches Protonentherapiezentrum Essen (WPE), Germany.
authors.forename: Emile N
authors.initials: EN
authors.lastname: van Lin
authors.affiliation: Department of Urology, Maastricht University Medical Center+, The Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: van de Beek
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: van Loon
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, The Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, The Netherlands.
authors.forename: Bram L
authors.initials: BL
authors.lastname: Ramaekers
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, The Netherlands.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambin
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D006801:Humans; D008297:Male; D008390:Markov Chains; D011471:Prostatic Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D019057:Quality-Adjusted Life Years; D011832:Radiation Injuries / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000191:economics / Q000379:methods
keywords: Cost-effectiveness; Prostate cancer; Radiotherapy; Spacer; Toxicity-reduction