Individualized positron emission tomography-based isotoxic accelerated radiation therapy is cost-effective compared with conventional radiation therapy: a model-based evaluation

Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):857-65. doi: 10.1016/j.ijrobp.2014.12.012.

Abstract

Purpose: To evaluate long-term health effects, costs, and cost-effectiveness of positron emission tomography (PET)-based isotoxic accelerated radiation therapy treatment (PET-ART) compared with conventional fixed-dose CT-based radiation therapy treatment (CRT) in non-small cell lung cancer (NSCLC).

Methods and materials: Our analysis uses a validated decision model, based on data of 200 NSCLC patients with inoperable stage I-IIIB. Clinical outcomes, resource use, costs, and utilities were obtained from the Maastro Clinic and the literature. Primary model outcomes were the difference in life-years (LYs), quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness and cost/utility ratio (ICER and ICUR) of PET-ART versus CRT. Model outcomes were obtained from averaging the predictions for 50,000 simulated patients. A probabilistic sensitivity analysis and scenario analyses were carried out.

Results: The average incremental costs per patient of PET-ART were €569 (95% confidence interval [CI] €-5327-€6936) for 0.42 incremental LYs (95% CI 0.19-0.61) and 0.33 QALYs gained (95% CI 0.13-0.49). The base-case scenario resulted in an ICER of €1360 per LY gained and an ICUR of €1744 per QALY gained. The probabilistic analysis gave a 36% probability that PET-ART improves health outcomes at reduced costs and a 64% probability that PET-ART is more effective at slightly higher costs.

Conclusion: On the basis of the available data, individualized PET-ART for NSCLC seems to be cost-effective compared with CRT.

Publication types

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

MeSH terms

  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / radiotherapy*
  • Confidence Intervals
  • Cost-Benefit Analysis
  • Disease Progression
  • Health Status
  • Humans
  • Lung Neoplasms / pathology
  • Lung Neoplasms / radiotherapy*
  • Positron-Emission Tomography / adverse effects
  • Positron-Emission Tomography / economics*
  • Precision Medicine / adverse effects
  • Precision Medicine / economics*
  • Quality of Life
  • Quality-Adjusted Life Years
  • Radiotherapy Dosage
  • Sensitivity and Specificity
  • Uncertainty