Cost of Intensity-modulated Radiation Therapy for Older Patients with Stage III Lung Cancer.
In the treatment of stage III non-small cell lung cancer (NSCLC), three-dimensional conformal radiotherapy (3D-RT) is the standard method for radiation delivery; however, intensity-modulated radiotherapy (IMRT) has been rapidly adopted. These two modalities may lead to similar survival, warranting a closer scrutiny of the costs involved.



The purpose of this study is to compare radiotherapy-related and total costs of older patients with NSCLC treated with 3D-RT versus IMRT.



We conducted a population-based study of all Medicare beneficiaries aged 65 years or older in a Surveillance, Epidemiology and End Results region. Patients were diagnosed with stage III NSCLC diagnosed between 2002 and 2009. Patients received IMRT or 3D-RT in combination with chemotherapy within 4 months of diagnosis. Radiotherapy-related and total adjusted cost and survival of patients receiving 3D-RT versus IMRT were compared using propensity scores methods.



Of the 2,418 patients in study, 314 (13%) received IMRT. Adjusted analyses showed no difference in overall survival (hazard ratio, 0.97; 95% confidence interval [CI], 0.85-1.12) in patients treated with 3D-RT versus IMRT. After adjusting for propensity scores, RT-related costs (estimated difference, $6,850; 95% CI, $5,532-$8,168) and total costs (estimated difference, $8,713; 95% CI, $4,376-$13,051) were significantly higher among patients undergoing IMRT.



The rapid adoption of IMRT for the treatment of stage III NSCLC has occurred in the absence of evidence from prospective randomized trials. Our results show that IMRT is associated with similar survival but increased costs, underscoring the need for continued research in IMRT and other new technologies.
1 Division of General Internal Medicine, Department of Medicine.
Minal S
MS
Kale
1 Division of General Internal Medicine, Department of Medicine.
Grace
G
Mhango
2 Division of Hematology and Oncology, Wake Forest University, Winston-Salem, North Carolina.
Marcelo
M
Bonomi
1 Division of General Internal Medicine, Department of Medicine.
Alex
A
Federman
1 Division of General Internal Medicine, Department of Medicine.
Keith
K
Sigel
3 Department of Radiation Oncology, and.
Kenneth E
KE
Rosenzweig
1 Division of General Internal Medicine, Department of Medicine.|4 Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; and.
Juan P
JP
Wisnivesky
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D057216:Propensity Score; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics*; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
cost–benefit analysis; lung neoplasms; radiotherapy