Individualized positron emission tomography-based isotoxic accelerated radiation therapy is cost-effective compared with conventional radiation therapy: a model-based evaluation

Mathilda L Bongers, Veerle M H Coupé, Dirk De Ruysscher, Cary Oberije, Philippe Lambin, Carin A Uyl-de Groot, Cornelia A Uyl-de Groot
International Journal of Radiation Oncology, Biology, Physics 2015 March 15, 91 (4): 857-65

PURPOSE: To evaluate long-term health effects, costs, and cost-effectiveness of positron emission tomography (PET)-based isotoxic accelerated radiation therapy treatment (PET-ART) compared with conventional fixed-dose CT-based radiation therapy treatment (CRT) in non-small cell lung cancer (NSCLC).

METHODS AND MATERIALS: Our analysis uses a validated decision model, based on data of 200 NSCLC patients with inoperable stage I-IIIB. Clinical outcomes, resource use, costs, and utilities were obtained from the Maastro Clinic and the literature. Primary model outcomes were the difference in life-years (LYs), quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness and cost/utility ratio (ICER and ICUR) of PET-ART versus CRT. Model outcomes were obtained from averaging the predictions for 50,000 simulated patients. A probabilistic sensitivity analysis and scenario analyses were carried out.

RESULTS: The average incremental costs per patient of PET-ART were €569 (95% confidence interval [CI] €-5327-€6936) for 0.42 incremental LYs (95% CI 0.19-0.61) and 0.33 QALYs gained (95% CI 0.13-0.49). The base-case scenario resulted in an ICER of €1360 per LY gained and an ICUR of €1744 per QALY gained. The probabilistic analysis gave a 36% probability that PET-ART improves health outcomes at reduced costs and a 64% probability that PET-ART is more effective at slightly higher costs.

CONCLUSION: On the basis of the available data, individualized PET-ART for NSCLC seems to be cost-effective compared with CRT.

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