title: Economic evaluation of single-fraction versus multiple-fraction palliative radiotherapy for painful bone metastases in breast, lung and prostate cancer.
abstract: BACKGROUND
  Single- and multiple-fraction external beam radiotherapy (SFX-EBRT and MFX-EBRT) are palliative treatment options for localized metastatic bone pain. MFX is the preferred choice in many developed countries. Evidence shows little difference in how effectively SFX and MFX reduce pain. However, SFX is associated with higher retreatment and (in one meta-analysis) pathological fracture rates. MFX is, however, more time-consuming and expensive. We estimated the cost-effectiveness of SFX versus MFX for metastatic bone pain in breast, prostate and lung cancer in New Zealand.
  
  
  METHODS
  We constructed a Markov microsimulation model to estimate health gain (in quality-adjusted life-years or QALYs), health system costs (in real 2011 NZ dollars) and cost-effectiveness. The model was populated using effect estimates from randomized controlled trials and other studies, and New Zealand cancer and cost data. Disability weights from the 2010 Global Burden of Disease study were used in estimating QALYs.
  
  
  RESULTS
  Across all three cancers, QALY gains were similar for SFX compared to MFX, and per patient costs were less for SFX than MFX, with a difference of NZ$1469 (95% uncertainty interval $1112 to $1886) for lung cancer, $1316 ($810 to $1854) for prostate cancer and $1344 ($855 to $1846) for breast cancer. Accordingly, from a cost-effectiveness perspective, SFX was the preferable treatment option. Various sensitivity analyses did not overturn the clear preference for SFX.
  
  
  CONCLUSIONS
  For all three cancers, SFX was clearly more cost-effective than MFX. This adds to the case for desisting from offering MFX to patients with metastatic bone pain, from a cost-effectiveness angle.
authors.affiliation: Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Lucie
authors.initials: L
authors.lastname: Collinson
authors.affiliation: Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Kvizhinadze
authors.affiliation: Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand. nisha.nair@otago.ac.nz.
authors.forename: Nisha
authors.initials: N
authors.lastname: Nair
authors.affiliation: Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Melissa
authors.initials: M
authors.lastname: McLeod
authors.affiliation: Burden of Disease, Epidemiology, Equity and Cost Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Tony
authors.initials: T
authors.lastname: Blakely
mesh_terms: D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy*; D001943:Breast Neoplasms / Q000628:therapy; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D009520:New Zealand; D010166:Palliative Care / Q000191:economics; D011471:Prostatic Neoplasms / Q000628:therapy; D019057:Quality-Adjusted Life Years; D011878:Radiotherapy / Q000191:economics* / Q000379:methods*
keywords: bone pain; cost-effectiveness analysis; metastatic cancer; radiotherapy; single fraction