The cost-effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of brain metastasis in Vietnam from the perspective of patients and families

World Neurosurg. 2012 Feb;77(2):321-8. doi: 10.1016/j.wneu.2011.05.050. Epub 2011 Nov 7.

Abstract

Background: This study aims to evaluate the cost-effectiveness of the treatment of brain metastasis with surgical resection (SR) and stereotactic radiosurgery (SRS) in the lower-middle-income country of Vietnam from the perspective of patients and families.

Methods: The treatment of 111 patients with brain metastases who underwent SR (n = 64) and SRS (n = 47) was retrospectively reviewed. Propensity score matching was used to adjust for selection bias (n = 30 each); mean and curves of survival time were defined by the Kaplan-Meier estimator; the cost analysis focused on the time period of relevant treatment.

Results: The mean survival times of SRS and SR were 11.9 and 10.5 months, and the 18-month survival rates were 32% and 14%, respectively (P = 0.346). The mean number of hospital bed days was significantly higher for SR than SRS (16.5 versus 7.6 days, P < 0.05), but direct costs of SR were significantly lower (14.5 as opposed to 35.3 million Vietnamese dong [VND] per patient, P < 0.001). However, indirect costs of SR were 10 times higher (26.0 versus 2.5 million VND per patient, P < 0.001). The cost per life year gained was higher for SR than SRS (46.4 and 38.1 million VND, respectively).

Conclusions: SRS is similarly effective as SR. However, in the broader context of the cost-effectiveness from the perspective of patients and their families, SRS is more cost-effective. The lower costs directly charged by the hospital for SR may prevent poorer and older patients from choosing SRS. Thus, the overall cost-effectiveness of each treatment option should be taken into consideration in deciding on the treatment.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Algorithms
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / surgery*
  • Cohort Studies
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Data Interpretation, Statistical
  • Female
  • Humans
  • Income
  • Kaplan-Meier Estimate
  • Length of Stay
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Neurosurgical Procedures / economics*
  • Propensity Score
  • Radiosurgery / economics*
  • Retrospective Studies
  • Socioeconomic Factors
  • Survival
  • Vietnam
  • Young Adult