Journal article
Cost-effectiveness Analysis of Stereotactic Radiosurgery Alone Versus Stereotactic Radiosurgery with Upfront Whole Brain Radiation Therapy for Brain Metastases
Clinical oncology (Royal College of Radiologists (Great Britain)), v 29(10), pp e157-e164
01 Oct 2017
PMID: 28552517
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Stereotactic radiosurgery (SRS) alone or upfront whole brain radiation therapy (WBRT) plus SRS are the most commonly used treatment options for one to three brain oligometastases. The most recent randomised clinical trial result comparing SRS alone with upfront WBRT plus SRS (NCCTG N0574) has favoured SRS alone for neurocognitive function, whereas treatment options remain controversial in terms of cognitive decline and local control. The aim of this study was to conduct a cost-effectiveness analysis of these two competing treatments.
A Markov model was constructed for patients treated with SRS alone or SRS plus upfront WBRT based on largely randomised clinical trials. Costs were based on 2016 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio (ICER) and effectiveness was measured in quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were carried out. Strategies were evaluated from the healthcare payer's perspective with a willingness-to-pay threshold of $100 000 per QALY gained.
In the base case analysis, the median survival was 9 months for both arms. SRS alone resulted in an ICER of $9917 per QALY gained. In one-way sensitivity analyses, results were most sensitive to variation in cognitive decline rates for both groups and median survival rates, but the SRS alone remained cost-effective for most parameter ranges.
Based on the current available evidence, SRS alone was found to be cost-effective for patients with one to three brain metastases compared with upfront WBRT plus SRS.
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Details
- Title
- Cost-effectiveness Analysis of Stereotactic Radiosurgery Alone Versus Stereotactic Radiosurgery with Upfront Whole Brain Radiation Therapy for Brain Metastases
- Creators
- H Kim - UPMC Hillman Cancer CenterM S Rajagopalan - UPMC Hillman Cancer CenterS Beriwal - UPMC Hillman Cancer CenterK J Smith - University of Pittsburgh
- Publication Details
- Clinical oncology (Royal College of Radiologists (Great Britain)), v 29(10), pp e157-e164
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000414196000001
- Scopus ID
- 2-s2.0-85019945874
- Other Identifier
- 991021897256604721
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Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Oncology