Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma

Yushen Qian, Satoshi Maruyama, Haju Kim, Erqi L. Pollom, Kiran A. Kumar, Alexander L. Chin, Jeremy P. Harris, Daniel T. Chang, Allison Pitt, Eran Bendavid, Douglas K. Owens, Ben Y. Durkee, Scott G. Soltys

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background. The addition of procarbazine, lomustine, vincristine (PCV) chemotherapy to radiotherapy (RT) for patients with high-risk (=40 y old or subtotally resected) low-grade glioma (LGG) results in an absolute median survival benefit of over 5 years. We evaluated the cost-effectiveness of this treatment strategy. Methods. A decision tree with an integrated 3-state Markov model was created to follow patients with high-risk LGG after surgery treated with RT versus RT + PCV. Patients existed in one of 3 health states: stable, progressive, or dead. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using timedependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Analysis was conducted from the health care perspective. Deterministic and probabilistic sensitivity analysis explored uncertainty in model parameters. Results. Modeled outcomes demonstrated agreement with clinical data in expected benefit of addition of PCV to RT. The addition of PCV to RT yielded an incremental benefit of 4.77 quality-adjusted life-years (QALYs) (9.94 for RT + PCV vs 5.17 for RT alone) at an incremental cost of $48 635 ($188 234 for RT + PCV vs $139 598 for RT alone), resulting in an incremental cost-effectiveness ratio of $10 186 per QALY gained. Probabilistic sensitivity analysis demonstrates that within modeled distributions of parameters, RT + PCV has 99.96% probability of being costeffectiveness at a willingness-to-pay threshold of $100 000 per QALY. Conclusion. The addition of PCV to RT is a cost-effective treatment strategy for patients with high-risk LGG.

Original languageEnglish (US)
Pages (from-to)1651-1660
Number of pages10
JournalNeuro-oncology
Volume19
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Lomustine
Procarbazine
Glioma
Cost-Benefit Analysis
Radiotherapy
Vincristine
Radiation
Drug Therapy
Quality-Adjusted Life Years
Costs and Cost Analysis
Decision Trees
Survival
Health
Health Care Costs
Uncertainty
Registries
Databases
Delivery of Health Care

Keywords

  • brain tumor
  • chemotherapy
  • cost-effectiveness analysis
  • low-grade glioma
  • radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

Cite this

Qian, Y., Maruyama, S., Kim, H., Pollom, E. L., Kumar, K. A., Chin, A. L., ... Soltys, S. G. (2017). Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma. Neuro-oncology, 19(12), 1651-1660. https://doi.org/10.1093/neuonc/nox121

Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma. / Qian, Yushen; Maruyama, Satoshi; Kim, Haju; Pollom, Erqi L.; Kumar, Kiran A.; Chin, Alexander L.; Harris, Jeremy P.; Chang, Daniel T.; Pitt, Allison; Bendavid, Eran; Owens, Douglas K.; Durkee, Ben Y.; Soltys, Scott G.

In: Neuro-oncology, Vol. 19, No. 12, 01.12.2017, p. 1651-1660.

Research output: Contribution to journalArticle

Qian, Y, Maruyama, S, Kim, H, Pollom, EL, Kumar, KA, Chin, AL, Harris, JP, Chang, DT, Pitt, A, Bendavid, E, Owens, DK, Durkee, BY & Soltys, SG 2017, 'Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma', Neuro-oncology, vol. 19, no. 12, pp. 1651-1660. https://doi.org/10.1093/neuonc/nox121
Qian, Yushen ; Maruyama, Satoshi ; Kim, Haju ; Pollom, Erqi L. ; Kumar, Kiran A. ; Chin, Alexander L. ; Harris, Jeremy P. ; Chang, Daniel T. ; Pitt, Allison ; Bendavid, Eran ; Owens, Douglas K. ; Durkee, Ben Y. ; Soltys, Scott G. / Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma. In: Neuro-oncology. 2017 ; Vol. 19, No. 12. pp. 1651-1660.
@article{87e91730f192456db21cf92dafd8992a,
title = "Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma",
abstract = "Background. The addition of procarbazine, lomustine, vincristine (PCV) chemotherapy to radiotherapy (RT) for patients with high-risk (=40 y old or subtotally resected) low-grade glioma (LGG) results in an absolute median survival benefit of over 5 years. We evaluated the cost-effectiveness of this treatment strategy. Methods. A decision tree with an integrated 3-state Markov model was created to follow patients with high-risk LGG after surgery treated with RT versus RT + PCV. Patients existed in one of 3 health states: stable, progressive, or dead. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using timedependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Analysis was conducted from the health care perspective. Deterministic and probabilistic sensitivity analysis explored uncertainty in model parameters. Results. Modeled outcomes demonstrated agreement with clinical data in expected benefit of addition of PCV to RT. The addition of PCV to RT yielded an incremental benefit of 4.77 quality-adjusted life-years (QALYs) (9.94 for RT + PCV vs 5.17 for RT alone) at an incremental cost of $48 635 ($188 234 for RT + PCV vs $139 598 for RT alone), resulting in an incremental cost-effectiveness ratio of $10 186 per QALY gained. Probabilistic sensitivity analysis demonstrates that within modeled distributions of parameters, RT + PCV has 99.96{\%} probability of being costeffectiveness at a willingness-to-pay threshold of $100 000 per QALY. Conclusion. The addition of PCV to RT is a cost-effective treatment strategy for patients with high-risk LGG.",
keywords = "brain tumor, chemotherapy, cost-effectiveness analysis, low-grade glioma, radiotherapy",
author = "Yushen Qian and Satoshi Maruyama and Haju Kim and Pollom, {Erqi L.} and Kumar, {Kiran A.} and Chin, {Alexander L.} and Harris, {Jeremy P.} and Chang, {Daniel T.} and Allison Pitt and Eran Bendavid and Owens, {Douglas K.} and Durkee, {Ben Y.} and Soltys, {Scott G.}",
year = "2017",
month = "12",
day = "1",
doi = "10.1093/neuonc/nox121",
language = "English (US)",
volume = "19",
pages = "1651--1660",
journal = "Neuro-Oncology",
issn = "1522-8517",
publisher = "Oxford University Press",
number = "12",

}

TY - JOUR

T1 - Cost-effectiveness of radiation and chemotherapy for high-risk low-grade glioma

AU - Qian, Yushen

AU - Maruyama, Satoshi

AU - Kim, Haju

AU - Pollom, Erqi L.

AU - Kumar, Kiran A.

AU - Chin, Alexander L.

AU - Harris, Jeremy P.

AU - Chang, Daniel T.

AU - Pitt, Allison

AU - Bendavid, Eran

AU - Owens, Douglas K.

AU - Durkee, Ben Y.

AU - Soltys, Scott G.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background. The addition of procarbazine, lomustine, vincristine (PCV) chemotherapy to radiotherapy (RT) for patients with high-risk (=40 y old or subtotally resected) low-grade glioma (LGG) results in an absolute median survival benefit of over 5 years. We evaluated the cost-effectiveness of this treatment strategy. Methods. A decision tree with an integrated 3-state Markov model was created to follow patients with high-risk LGG after surgery treated with RT versus RT + PCV. Patients existed in one of 3 health states: stable, progressive, or dead. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using timedependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Analysis was conducted from the health care perspective. Deterministic and probabilistic sensitivity analysis explored uncertainty in model parameters. Results. Modeled outcomes demonstrated agreement with clinical data in expected benefit of addition of PCV to RT. The addition of PCV to RT yielded an incremental benefit of 4.77 quality-adjusted life-years (QALYs) (9.94 for RT + PCV vs 5.17 for RT alone) at an incremental cost of $48 635 ($188 234 for RT + PCV vs $139 598 for RT alone), resulting in an incremental cost-effectiveness ratio of $10 186 per QALY gained. Probabilistic sensitivity analysis demonstrates that within modeled distributions of parameters, RT + PCV has 99.96% probability of being costeffectiveness at a willingness-to-pay threshold of $100 000 per QALY. Conclusion. The addition of PCV to RT is a cost-effective treatment strategy for patients with high-risk LGG.

AB - Background. The addition of procarbazine, lomustine, vincristine (PCV) chemotherapy to radiotherapy (RT) for patients with high-risk (=40 y old or subtotally resected) low-grade glioma (LGG) results in an absolute median survival benefit of over 5 years. We evaluated the cost-effectiveness of this treatment strategy. Methods. A decision tree with an integrated 3-state Markov model was created to follow patients with high-risk LGG after surgery treated with RT versus RT + PCV. Patients existed in one of 3 health states: stable, progressive, or dead. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using timedependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Analysis was conducted from the health care perspective. Deterministic and probabilistic sensitivity analysis explored uncertainty in model parameters. Results. Modeled outcomes demonstrated agreement with clinical data in expected benefit of addition of PCV to RT. The addition of PCV to RT yielded an incremental benefit of 4.77 quality-adjusted life-years (QALYs) (9.94 for RT + PCV vs 5.17 for RT alone) at an incremental cost of $48 635 ($188 234 for RT + PCV vs $139 598 for RT alone), resulting in an incremental cost-effectiveness ratio of $10 186 per QALY gained. Probabilistic sensitivity analysis demonstrates that within modeled distributions of parameters, RT + PCV has 99.96% probability of being costeffectiveness at a willingness-to-pay threshold of $100 000 per QALY. Conclusion. The addition of PCV to RT is a cost-effective treatment strategy for patients with high-risk LGG.

KW - brain tumor

KW - chemotherapy

KW - cost-effectiveness analysis

KW - low-grade glioma

KW - radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=85040058207&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040058207&partnerID=8YFLogxK

U2 - 10.1093/neuonc/nox121

DO - 10.1093/neuonc/nox121

M3 - Article

C2 - 28666368

AN - SCOPUS:85040058207

VL - 19

SP - 1651

EP - 1660

JO - Neuro-Oncology

JF - Neuro-Oncology

SN - 1522-8517

IS - 12

ER -