title: Cost-Effectiveness Analysis of Intensity Modulated Radiation Therapy Versus 3-Dimensional Conformal Radiation Therapy for Preoperative Treatment of Extremity Soft Tissue Sarcomas.
abstract: OBJECTIVE
  Create a cost-effectiveness model comparing preoperative intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT) for extremity soft tissue sarcomas.
  
  
  METHODS
  Input parameters included 5-year local recurrence rates, rates of acute wound adverse events, and chronic toxicities (edema, fracture, joint stiffness, and fibrosis). Health-state utilities were used to calculate quality-adjusted life years (QALYs). Overall treatment costs per QALY or incremental cost-effectiveness ratio (ICER) were calculated. Roll-back analysis was performed using average costs and utilities to determine the baseline preferred radiation technique. One-way, 2-way, and probabilistic sensitivity analyses (PSA) were performed for input parameters with the largest impact on the ICER.
  
  
  RESULTS
  Overall treatment costs were $17,515.58 for 3DCRT compared with $22,920.51 for IMRT. The effectiveness was higher for IMRT (3.68 QALYs) than for 3DCRT (3.35 QALYs). The baseline ICER for IMRT was $16,842.75/QALY, making it the preferable treatment. The ICER was most sensitive to the probability of local recurrence, upfront radiation costs, local recurrence costs, certain utilities (no toxicity/no recurrence, grade 1 toxicity/no local recurrence, grade 4 toxicity/no local recurrence), and life expectancy. Dominance patterns emerged when the cost of 3DCRT exceeded $15,532.05 (IMRT dominates) or the life expectancy was under 1.68 years (3DCRT dominates). Furthermore, preference patterns changed based on the rate of local recurrence (threshold: 13%). The PSA results demonstrated that IMRT was the preferred cost-effective technique for 64% of trials compared with 36% for 3DCRT.
  
  
  CONCLUSIONS
  Based on our model, IMRT is the preferred technique by lowering rates of local recurrence, severe toxicities, and improving QALYs. From a third-party payer perspective, IMRT should be a supported approach for extremity soft tissue sarcomas.
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle, Washington. Electronic address: patrjr@uw.edu.
authors.forename: Patrick
authors.initials: P
authors.lastname: Richard
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle, Washington.
authors.forename: Mark
authors.initials: M
authors.lastname: Phillips
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle, Washington.
authors.forename: Wade
authors.initials: W
authors.lastname: Smith
authors.affiliation: Department of Orthopedic Surgery, University of Washington, Seattle, Washington.
authors.forename: Darin
authors.initials: D
authors.lastname: Davidson
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle, Washington.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle, Washington.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Kane
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005121:Extremities; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009364:Neoplasm Recurrence, Local / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D011300:Preoperative Care / Q000191:economics; D015995:Prevalence; D011832:Radiation Injuries / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant / Q000191:economics; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000191:economics* / Q000401:mortality / Q000532:radiotherapy*; D014861:Washington / Q000453:epidemiology