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
N1 - Funding Information:
The authors sincerely thank the following research groups who agreed to share their data: Arbeitsgemeinschaft Radioonkologie der Deutschen Krebsgesellschaft, Eastern Cooperative Oncology Group, Medical Research Council, North Central Cancer Treatment Group, and Radiation Therapy Oncology Group. The contents of this publication and methods used are solely the responsibility of the authors. This study was supported by an unrestricted research grant (No. 152002021) from the Dutch Organization of Health Research and Development (ZonMw) and the French National League against Cancer. ZonMw and the French National League against Cancer had no influence on the study design, data analyses, data interpretation, article writing, or the decision to submit the article for publication.
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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U2 - 10.1097/JTO.0b013e31829f6c55
DO - 10.1097/JTO.0b013e31829f6c55
M3 - Article
C2 - 24457241
AN - SCOPUS:84892412111
SN - 1556-0864
VL - 8
SP - 1295
EP - 1307
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
IS - 10
ER -