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Cost-Effectiveness Analysis of Stereotactic Body Radiation (SBRT) versus Intensity-Modulated Radiation Therapy (IMRT) For Low or Intermediate Risk Prostate Cancer: A Markov Model Decision Analysis
May 1, 2012
J. C. Hodges, T. Boike, Y. Lotan, R. Benton, D. A. Pistenmaa, H. Choy, R. Timmerman, Department of Radiation Oncology,
University of Texas Southwestern Medical Center, Dallas, TX, Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
Purpose/Objective(s): In several recent phase I and II clinical trials, stereotactic body radiation therapy (SBRT) for low or intermediate risk prostate cancer has shown high levels of biochemical control and equally low toxicity burden compared to intensity modulated radiation therapy (IMRT). The purpose of this study is to compare the cost effectiveness of two external beam radiation therapy techniques of SBRT and IMRT for low or intermediate risk prostate cancer.
Materials/Methods: A Markov decision tree with probabilistic sensitivity analysis modeling the various disease states of a 70 year old patient with low or intermediate risk prostate cancer was developed. Model assumptions were based on a recent random effects meta-analysis; extensive literature review of costs, utilities, transition rates; and our institutional cost data for evaluation, treatment planning and delivery. Two different prostate radiation techniques were considered: 1) SBRT 35-50 Gy in 5 fractions; 2) IMRT 79.2 Gy in 44 fractions.
Results: The costs for SBRT were analyzed based on delivery with a non robotic linear accelerator consistent with our institution’s SBRT treatment techniques. Given a recent report of 5 year outcomes data with SBRT, the base case assumed equal efficacy and quality of life. At ten years follow up, the Monte Carlo simulation revealed that the mean costs and quality adjusted life years (QALYs) for SBRT and IMRT were $19,155 (7.9) and $32,468 (7.9), respectively. In addition, in order to investigate the effect of relaxing the base case assumptions, sensitivity analysis was performed by varying the efficacy and quality of life of patients treated with SBRT. This sensitivity analysis revealed that a decrease in quality of life of 3.5% or a decrease in efficacy of 8% for patients treated with SBRT would no longer render an incremental cost-effectiveness ratio of <$50,000 per QALY when comparing SBRT to IMRT.
Conclusions: Compared to IMRT, SBRT for low or intermediate prostate cancer has great potential cost savings for our healthcare system and may improve access to radiation, increase patient convenience, and boost quality of life for patients. Our model also suggests that the incremental cost effectiveness ratio of SBRT over IMRT is highly sensitive to quality of life outcomes which should be adequately and comparably measured in current and future prostate SBRT studies.
Author Disclosure: J.C. Hodges: None. T. Boike: None. Y. Lotan: None. R. Benton: None. D.A. Pistenmaa: None. H. Choy: None. R. Timmerman: B. Research Grant; Department of Defense.