title: Cost and effectiveness of image-guided radiotherapy for non-operated localized lung cancer: a population-based propensity score-matched analysis.
abstract: BACKGROUND
  Image-guided radiotherapy (IGRT) is a novel technology to enhance RT delivery accuracy. However, the clinical effectiveness and cost-effectiveness are less clear. The aim of our study is to compare the cost and effectiveness of conventional fractionated RT for non-operated localized lung cancer delivered with vs. without IGRT via this population-based propensity score (PS) matched analysis.
  
  
  METHODS
  We identified eligible patients diagnosed within 2007-2010 through a comprehensive population-based database containing cancer, death registries, and reimbursement data in Taiwan. The primary duration of interest (DOI) was 2 years within diagnosis. Effectiveness was measured as survival whereas direct medical cost was measured from the payers' perspective. In supplementary analysis (SA), we estimated the cost-effectiveness in consider of out-of-pocket (OOP) payment and 4 years as DOI.
  
  
  RESULTS
  Our study population constituted 124 patients. Within 2 years, both the mean cost (2014 USD) and survival (life-year, LY) were higher for IGRT ($60,774 vs. $60,554; 1.43 vs. 1.37). The incremental cost-effectiveness ratio (ICER) when IGRT was compared to non-IGRT was 3,667 (USD/LY). The chance for IGRT to be cost-effective was around 68% & 70% at willingness-to-pay threshold 50,000 USD/LY and 150,000 USD/LY respectively. IGRT remained cost-effective in SA.
  
  
  CONCLUSIONS
  We provide the first empirical evidence that when compared to non-IGRT, IGRT was potentially cost-effective.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Hsia
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Fang
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Ji-An
authors.initials: JA
authors.lastname: Liang
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Chia-Chin
authors.initials: CC
authors.lastname: Li
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan.
authors.forename: Chun-Ru
authors.initials: CR
authors.lastname: Chien
keywords: Cost effectiveness analysis; image-guided radiotherapy (IGRT); lung cancer