title: Cost-effectiveness of prophylactic cranial irradiation with hippocampal avoidance in limited stage small cell lung cancer.
abstract: Prophylactic cranial irradiation (PCI) in limited stage small cell lung cancer (LS-SCLC) prevents brain metastases and improves survival, with the potential for neurocognitive toxicity. RTOG0933 demonstrated that hippocampal avoidance (HA) during whole brain radiotherapy preserves neurocognition. This study's objective was to evaluate the cost-effectiveness of HA-PCI in LS-SCLC through decision analysis.
  
  
  
  A Markov model was developed to simulate the clinical course of LS-SCLC who received HA-PCI or conventional PCI (C-PCI). A willingness-to-pay threshold of $100,000/QALY was used. Incremental cost effectiveness ratio was calculated (ICER). Sensitivity analyses were performed to determine the parameter thresholds and to assess the robustness of the model.
  
  
  
  In the base case scenario, HA-PCI is more cost-effective than C-PCI, with an ICER of $47,107/QALY. HA-PCI was preferred over C-PCI provided that the risk of developing brain metastases was not increased by at least 14%, or if neurocognitive dysfunction rates were reduced by at least 40%. HA-PCI was the cost-effective strategy in 68% of tested iterations in probabilistic sensitivity analysis.
  
  
  
  This study demonstrates that HA-PCI is more cost-effective than C-PCI in LS-SCLC. Our results support the use of HA-PCI in this patient population, should results from RTOG0933 be confirmed by the ongoing NRGCC003 trial.
authors.affiliation: Queen's University, Kingston, ON, Canada.
authors.forename: Xuanlu M
authors.initials: XM
authors.lastname: Qu
authors.affiliation: University of Maryland, Baltimore, MD, USA.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Mishra
authors.affiliation: London Health Sciences Center, ON, Canada.
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Bauman
authors.affiliation: VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: Slotman
authors.affiliation: Miami Cancer Institute, FL, USA.
authors.forename: Minesh
authors.initials: M
authors.lastname: Mehta
authors.affiliation: Northwestern Medicine Cancer Chicago Center Warrenville and Northwestern Medicine Chicago Proton Center, Northwestern University, IL, USA.
authors.forename: Vinai
authors.initials: V
authors.lastname: Gondi
authors.affiliation: London Health Sciences Center, ON, Canada. Electronic address: Alexander.Louie@londonhospitals.ca.
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Louie
mesh_terms: D001932:Brain Neoplasms / Q000517:prevention & control* / Q000556:secondary*; D060825:Cognitive Dysfunction / Q000209:etiology; D003362:Cost-Benefit Analysis; D016371:Cranial Irradiation / Q000009:adverse effects / Q000191:economics; D003661:Decision Support Techniques; D006624:Hippocampus / Q000528:radiation effects*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D019057:Quality-Adjusted Life Years; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*
keywords: Cost-effectiveness analysis; Hippocampal avoidance; Limited stage small cell lung cancer; Prophylactic cranial irradiation