Individualized positron emission tomography-based isotoxic accelerated radiation therapy is cost-effective compared with conventional radiation therapy: a model-based evaluation.
OBJECTIVE
To evaluate long-term health effects, costs, and cost-effectiveness of positron emission tomography (PET)-based isotoxic accelerated radiation therapy treatment (PET-ART) compared with conventional fixed-dose CT-based radiation therapy treatment (CRT) in non-small cell lung cancer (NSCLC).


METHODS
Our analysis uses a validated decision model, based on data of 200 NSCLC patients with inoperable stage I-IIIB. Clinical outcomes, resource use, costs, and utilities were obtained from the Maastro Clinic and the literature. Primary model outcomes were the difference in life-years (LYs), quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness and cost/utility ratio (ICER and ICUR) of PET-ART versus CRT. Model outcomes were obtained from averaging the predictions for 50,000 simulated patients. A probabilistic sensitivity analysis and scenario analyses were carried out.


RESULTS
The average incremental costs per patient of PET-ART were €569 (95% confidence interval [CI] €-5327-€6936) for 0.42 incremental LYs (95% CI 0.19-0.61) and 0.33 QALYs gained (95% CI 0.13-0.49). The base-case scenario resulted in an ICER of €1360 per LY gained and an ICUR of €1744 per QALY gained. The probabilistic analysis gave a 36% probability that PET-ART improves health outcomes at reduced costs and a 64% probability that PET-ART is more effective at slightly higher costs.


CONCLUSIONS
On the basis of the available data, individualized PET-ART for NSCLC seems to be cost-effective compared with CRT.
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: ml.bongers@vumc.nl.
Mathilda L
ML
Bongers
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
Veerle M H
VM
Coupé
Radiation Oncology University Hospitals Leuven/KU Leuven, Leuven, Belgium; Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.
Dirk
D
De Ruysscher
Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.
Cary
C
Oberije
Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.
Philippe
P
Lambin
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Carin A
CA
Uyl-de Groot
Cornelia A
CA
Uyl-de Groot
D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D049268:Positron-Emission Tomography / Q000009:adverse effects / Q000191:economics*; D057285:Precision Medicine / Q000009:adverse effects / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011879:Radiotherapy Dosage; D012680:Sensitivity and Specificity; D035501:Uncertainty