title: The cost-effectiveness of surgical resection and cesium-131 intraoperative brachytherapy versus surgical resection and stereotactic radiosurgery in the treatment of metastatic brain tumors.
abstract: This study aims to evaluate the cost-effectiveness of surgical resection (S) and Cesium-131 (Cs-131) [S + Cs-131] intraoperative brachytherapy versus S and stereotactic radiosurgery (SRS) [S + SRS] for the treatment of brain metastases. Treatment records as well as hospital and outpatient charts of 49 patients with brain metastases between 2008 and 2012 who underwent S + Cs-131 (n = 24) and S + SRS (n = 25) were retrospectively reviewed. Hospital charges were compared for the single treatment in question. Means and curves of survival time were defined by the Kaplan-Meier estimator, with the cost analysis focusing on the time period of the relevant treatment. Quality adjusted life years (QALY) and Incremental cost-effectiveness ratios (ICER) were calculated for each treatment option as a measure of cost-effectiveness. The direct hospital costs of treatments per patient were: S + Cs131 = $19,271 and S + SRS = $44,219. The median survival times of S + Cs-131 and S + SRS were 15.5 and 11.3 months, and the 12 month survival rates were 61 % and 49 % (P = 0.137). The QALY for S + SRS when compared to S + Cs-131 yielded a p < 0.0001, making it significantly more cost-effective. The ICER also revealed that when compared to S + Cs-131, S + SRS was significantly inferior (p < 0.0001). S + Cs-131 is more cost-effective compared with S + SRS based on hospital charges as well as QALYs and ICER. Cost effectiveness, in addition to efficacy and risk, should factor into the comparison between these two treatment modalities for patients with surgically resectable brain metastases.
authors.affiliation: Department of Radiation Oncology, Stich Radiation Oncology, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA. gaw9008@med.cornell.edu.|Department of Neurological Surgery, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA. gaw9008@med.cornell.edu.
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Wernicke
authors.affiliation: Department of Radiation Oncology, Stich Radiation Oncology, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA.
authors.forename: Menachem Z
authors.initials: MZ
authors.lastname: Yondorf
authors.affiliation: Department of Radiation Oncology, Stich Radiation Oncology, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA.
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Parashar
authors.affiliation: Department of Radiation Oncology, Stich Radiation Oncology, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA.
authors.forename: Dattatreyudu
authors.initials: D
authors.lastname: Nori
authors.affiliation: Department of Radiation Oncology, Stich Radiation Oncology, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Clifford Chao
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Boockvar
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Pannullo
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Stieg
authors.affiliation: Department of Neurological Surgery, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.|Department of Otolaryngology, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.|Department of Neuroscience, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000191:economics*; D001932:Brain Neoplasms / Q000191:economics* / Q000556:secondary / Q000628:therapy; D002588:Cesium Radioisotopes / Q000191:economics* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000191:economics*; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D002588:Cesium Radioisotopes
keywords: Brain metastases; Cesium-131 brachytherapy; Cost-effectiveness analysis; Economic evaluation; Incremental cost-effectiveness ratio (ICER); Quality adjusted life year (QALY); Stereotactic radiosurgery (SRS)