Cost effectiveness of modified fractionation radiotherapy versus conventional radiotherapy for unresected non-small-cell lung cancer patients

Bram L T Ramaekers, Manuela A. Joore, Béranger Lueza, Julia Bonastre, Audrey Mauguen, Jean Pierre Pignon, Cecile Le Pechoux, Dirk K M De Ruysscher, R. Arriagada, K. Bae, D. Ball, M. Baumann, K. Behrendt, C. P. Belani, J. Beresford, J. Bishop, J. A. Bonner, H. Choy, S. E. Dahlberg, D. De Ruysscher & 18 others S. Dische, P. Fournel, R. Koch, C. Le Péchoux, S. J. Mandrekar, A. Mauguen, F. Mornex, M. Nankivell, G. Nelson, M. K. Parmar, R. Paulus, J. P. Pignon, M. I. Saunders, W. Sause, S. E. Schild, A. T. Turrisi, A. Zajusz, Janneke P C Grutters

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Introduction: Modified fractionation radiotherapy (RT), delivering multiple fractions per day or shortening the overall treatment time, improves overall survival for non-small-cell lung cancer (NSCLC) patients compared with conventional fractionation RT (CRT). However, its cost effectiveness is unknown. Therefore, we aimed to examine and compare the cost effectiveness of different modified RT schemes and CRT in the curative treatment of unresected NSCLC patients. Methods: A probabilistic Markov model was developed based on individual patient data from the meta-analysis of radiotherapy in lung cancer (N = 2000). Dutch health care costs, quality-adjusted life years (QALYs), and net monetary benefits (NMBs) were compared between two accelerated schemes (very accelerated RT [VART] and moderately accelerated RT [MART]), two hyperfractionated schemes (using an identical (HRTI) or higher (HRTH) total treatment dose than CRT) and CRT. Results: All modified fractionations were more effective and costlier than CRT (1.12 QALYs, €24,360). VART and MART were most effective (1.30 and 1.32 QALYs) and cost €25,746 and €26,208, respectively. HRTI and HRTH yielded less QALYs than the accelerated schemes (1.27 and 1.14 QALYs), and cost €26,199 and €29,683, respectively. MART had the highest NMB (€79,322; 95% confidence interval [CI], €35,478-€133,648) and was the most cost-effective treatment followed by VART (€78,347; 95% CI, €64,635-€92,526). CRT had an NMB of €65,125 (95% CI, €54,663-€75,537). MART had the highest probability of being cost effective (43%), followed by VART (31%), HRTI (24%), HRTH (2%), and CRT (0%). Conclusion: Implementing accelerated RT is almost certainly more efficient than current practice CRT and should be recommended as standard RT for the curative treatment of unresected NSCLC patients not receiving concurrent chemo-radiotherapy.

Original languageEnglish (US)
Pages (from-to)1295-1307
Number of pages13
JournalJournal of Thoracic Oncology
Volume8
Issue number10
DOIs
StatePublished - 2013

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Non-Small Cell Lung Carcinoma
Cost-Benefit Analysis
Radiotherapy
Quality-Adjusted Life Years
Confidence Intervals
Costs and Cost Analysis
Health Care Costs
Dose Fractionation
Statistical Models
Therapeutics
Meta-Analysis
Lung Neoplasms
Survival

Keywords

  • Cost-benefit analysis
  • Dose fractionation
  • Markov chain
  • Non-small-cell lung cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Cost effectiveness of modified fractionation radiotherapy versus conventional radiotherapy for unresected non-small-cell lung cancer patients. / Ramaekers, Bram L T; Joore, Manuela A.; Lueza, Béranger; Bonastre, Julia; Mauguen, Audrey; Pignon, Jean Pierre; Le Pechoux, Cecile; De Ruysscher, Dirk K M; Arriagada, R.; Bae, K.; Ball, D.; Baumann, M.; Behrendt, K.; Belani, C. P.; Beresford, J.; Bishop, J.; Bonner, J. A.; Choy, H.; Dahlberg, S. E.; De Ruysscher, D.; Dische, S.; Fournel, P.; Koch, R.; Le Péchoux, C.; Mandrekar, S. J.; Mauguen, A.; Mornex, F.; Nankivell, M.; Nelson, G.; Parmar, M. K.; Paulus, R.; Pignon, J. P.; Saunders, M. I.; Sause, W.; Schild, S. E.; Turrisi, A. T.; Zajusz, A.; Grutters, Janneke P C.

In: Journal of Thoracic Oncology, Vol. 8, No. 10, 2013, p. 1295-1307.

Research output: Contribution to journalArticle

Ramaekers, BLT, Joore, MA, Lueza, B, Bonastre, J, Mauguen, A, Pignon, JP, Le Pechoux, C, De Ruysscher, DKM, Arriagada, R, Bae, K, Ball, D, Baumann, M, Behrendt, K, Belani, CP, Beresford, J, Bishop, J, Bonner, JA, Choy, H, Dahlberg, SE, De Ruysscher, D, Dische, S, Fournel, P, Koch, R, Le Péchoux, C, Mandrekar, SJ, Mauguen, A, Mornex, F, Nankivell, M, Nelson, G, Parmar, MK, Paulus, R, Pignon, JP, Saunders, MI, Sause, W, Schild, SE, Turrisi, AT, Zajusz, A & Grutters, JPC 2013, 'Cost effectiveness of modified fractionation radiotherapy versus conventional radiotherapy for unresected non-small-cell lung cancer patients', Journal of Thoracic Oncology, vol. 8, no. 10, pp. 1295-1307. https://doi.org/10.1097/JTO.0b013e31829f6c55
Ramaekers, Bram L T ; Joore, Manuela A. ; Lueza, Béranger ; Bonastre, Julia ; Mauguen, Audrey ; Pignon, Jean Pierre ; Le Pechoux, Cecile ; De Ruysscher, Dirk K M ; Arriagada, R. ; Bae, K. ; Ball, D. ; Baumann, M. ; Behrendt, K. ; Belani, C. P. ; Beresford, J. ; Bishop, J. ; Bonner, J. A. ; Choy, H. ; Dahlberg, S. E. ; De Ruysscher, D. ; Dische, S. ; Fournel, P. ; Koch, R. ; Le Péchoux, C. ; Mandrekar, S. J. ; Mauguen, A. ; Mornex, F. ; Nankivell, M. ; Nelson, G. ; Parmar, M. K. ; Paulus, R. ; Pignon, J. P. ; Saunders, M. I. ; Sause, W. ; Schild, S. E. ; Turrisi, A. T. ; Zajusz, A. ; Grutters, Janneke P C. / Cost effectiveness of modified fractionation radiotherapy versus conventional radiotherapy for unresected non-small-cell lung cancer patients. In: Journal of Thoracic Oncology. 2013 ; Vol. 8, No. 10. pp. 1295-1307.
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abstract = "Introduction: Modified fractionation radiotherapy (RT), delivering multiple fractions per day or shortening the overall treatment time, improves overall survival for non-small-cell lung cancer (NSCLC) patients compared with conventional fractionation RT (CRT). However, its cost effectiveness is unknown. Therefore, we aimed to examine and compare the cost effectiveness of different modified RT schemes and CRT in the curative treatment of unresected NSCLC patients. Methods: A probabilistic Markov model was developed based on individual patient data from the meta-analysis of radiotherapy in lung cancer (N = 2000). Dutch health care costs, quality-adjusted life years (QALYs), and net monetary benefits (NMBs) were compared between two accelerated schemes (very accelerated RT [VART] and moderately accelerated RT [MART]), two hyperfractionated schemes (using an identical (HRTI) or higher (HRTH) total treatment dose than CRT) and CRT. Results: All modified fractionations were more effective and costlier than CRT (1.12 QALYs, €24,360). VART and MART were most effective (1.30 and 1.32 QALYs) and cost €25,746 and €26,208, respectively. HRTI and HRTH yielded less QALYs than the accelerated schemes (1.27 and 1.14 QALYs), and cost €26,199 and €29,683, respectively. MART had the highest NMB (€79,322; 95{\%} confidence interval [CI], €35,478-€133,648) and was the most cost-effective treatment followed by VART (€78,347; 95{\%} CI, €64,635-€92,526). CRT had an NMB of €65,125 (95{\%} CI, €54,663-€75,537). MART had the highest probability of being cost effective (43{\%}), followed by VART (31{\%}), HRTI (24{\%}), HRTH (2{\%}), and CRT (0{\%}). Conclusion: Implementing accelerated RT is almost certainly more efficient than current practice CRT and should be recommended as standard RT for the curative treatment of unresected NSCLC patients not receiving concurrent chemo-radiotherapy.",
keywords = "Cost-benefit analysis, Dose fractionation, Markov chain, Non-small-cell lung cancer, Radiotherapy",
author = "Ramaekers, {Bram L T} and Joore, {Manuela A.} and B{\'e}ranger Lueza and Julia Bonastre and Audrey Mauguen and Pignon, {Jean Pierre} and {Le Pechoux}, Cecile and {De Ruysscher}, {Dirk K M} and R. Arriagada and K. Bae and D. Ball and M. Baumann and K. Behrendt and Belani, {C. P.} and J. Beresford and J. Bishop and Bonner, {J. A.} and H. Choy and Dahlberg, {S. E.} and {De Ruysscher}, D. and S. Dische and P. Fournel and R. Koch and {Le P{\'e}choux}, C. and Mandrekar, {S. J.} and A. Mauguen and F. Mornex and M. Nankivell and G. Nelson and Parmar, {M. K.} and R. Paulus and Pignon, {J. P.} and Saunders, {M. I.} and W. Sause and Schild, {S. E.} and Turrisi, {A. T.} and A. Zajusz and Grutters, {Janneke P C}",
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TY - JOUR

T1 - Cost effectiveness of modified fractionation radiotherapy versus conventional radiotherapy for unresected non-small-cell lung cancer patients

AU - Ramaekers, Bram L T

AU - Joore, Manuela A.

AU - Lueza, Béranger

AU - Bonastre, Julia

AU - Mauguen, Audrey

AU - Pignon, Jean Pierre

AU - Le Pechoux, Cecile

AU - De Ruysscher, Dirk K M

AU - Arriagada, R.

AU - Bae, K.

AU - Ball, D.

AU - Baumann, M.

AU - Behrendt, K.

AU - Belani, C. P.

AU - Beresford, J.

AU - Bishop, J.

AU - Bonner, J. A.

AU - Choy, H.

AU - Dahlberg, S. E.

AU - De Ruysscher, D.

AU - Dische, S.

AU - Fournel, P.

AU - Koch, R.

AU - Le Péchoux, C.

AU - Mandrekar, S. J.

AU - Mauguen, A.

AU - Mornex, F.

AU - Nankivell, M.

AU - Nelson, G.

AU - Parmar, M. K.

AU - Paulus, R.

AU - Pignon, J. P.

AU - Saunders, M. I.

AU - Sause, W.

AU - Schild, S. E.

AU - Turrisi, A. T.

AU - Zajusz, A.

AU - Grutters, Janneke P C

PY - 2013

Y1 - 2013

N2 - Introduction: Modified fractionation radiotherapy (RT), delivering multiple fractions per day or shortening the overall treatment time, improves overall survival for non-small-cell lung cancer (NSCLC) patients compared with conventional fractionation RT (CRT). However, its cost effectiveness is unknown. Therefore, we aimed to examine and compare the cost effectiveness of different modified RT schemes and CRT in the curative treatment of unresected NSCLC patients. Methods: A probabilistic Markov model was developed based on individual patient data from the meta-analysis of radiotherapy in lung cancer (N = 2000). Dutch health care costs, quality-adjusted life years (QALYs), and net monetary benefits (NMBs) were compared between two accelerated schemes (very accelerated RT [VART] and moderately accelerated RT [MART]), two hyperfractionated schemes (using an identical (HRTI) or higher (HRTH) total treatment dose than CRT) and CRT. Results: All modified fractionations were more effective and costlier than CRT (1.12 QALYs, €24,360). VART and MART were most effective (1.30 and 1.32 QALYs) and cost €25,746 and €26,208, respectively. HRTI and HRTH yielded less QALYs than the accelerated schemes (1.27 and 1.14 QALYs), and cost €26,199 and €29,683, respectively. MART had the highest NMB (€79,322; 95% confidence interval [CI], €35,478-€133,648) and was the most cost-effective treatment followed by VART (€78,347; 95% CI, €64,635-€92,526). CRT had an NMB of €65,125 (95% CI, €54,663-€75,537). MART had the highest probability of being cost effective (43%), followed by VART (31%), HRTI (24%), HRTH (2%), and CRT (0%). Conclusion: Implementing accelerated RT is almost certainly more efficient than current practice CRT and should be recommended as standard RT for the curative treatment of unresected NSCLC patients not receiving concurrent chemo-radiotherapy.

AB - Introduction: Modified fractionation radiotherapy (RT), delivering multiple fractions per day or shortening the overall treatment time, improves overall survival for non-small-cell lung cancer (NSCLC) patients compared with conventional fractionation RT (CRT). However, its cost effectiveness is unknown. Therefore, we aimed to examine and compare the cost effectiveness of different modified RT schemes and CRT in the curative treatment of unresected NSCLC patients. Methods: A probabilistic Markov model was developed based on individual patient data from the meta-analysis of radiotherapy in lung cancer (N = 2000). Dutch health care costs, quality-adjusted life years (QALYs), and net monetary benefits (NMBs) were compared between two accelerated schemes (very accelerated RT [VART] and moderately accelerated RT [MART]), two hyperfractionated schemes (using an identical (HRTI) or higher (HRTH) total treatment dose than CRT) and CRT. Results: All modified fractionations were more effective and costlier than CRT (1.12 QALYs, €24,360). VART and MART were most effective (1.30 and 1.32 QALYs) and cost €25,746 and €26,208, respectively. HRTI and HRTH yielded less QALYs than the accelerated schemes (1.27 and 1.14 QALYs), and cost €26,199 and €29,683, respectively. MART had the highest NMB (€79,322; 95% confidence interval [CI], €35,478-€133,648) and was the most cost-effective treatment followed by VART (€78,347; 95% CI, €64,635-€92,526). CRT had an NMB of €65,125 (95% CI, €54,663-€75,537). MART had the highest probability of being cost effective (43%), followed by VART (31%), HRTI (24%), HRTH (2%), and CRT (0%). Conclusion: Implementing accelerated RT is almost certainly more efficient than current practice CRT and should be recommended as standard RT for the curative treatment of unresected NSCLC patients not receiving concurrent chemo-radiotherapy.

KW - Cost-benefit analysis

KW - Dose fractionation

KW - Markov chain

KW - Non-small-cell lung cancer

KW - Radiotherapy

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