Cost-effectiveness analysis of intensity-modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

Eur J Cancer Care (Engl). 2018 Jan;27(1). doi: 10.1111/ecc.12430. Epub 2016 Jan 19.


The aim of our analysis was to compare the cost-effectiveness of high-dose intensity-modulated radiation therapy (IMRT) and hypofractionated intensity-modulated radiation therapy (HF-IMRT) versus conventional dose three-dimensional radiation therapy (3DCRT) for the treatment of localised prostate cancer. A Markov model was constructed to calculate the incremental quality-adjusted life years and costs. Transition probabilities, adverse events and utilities were derived from relevant systematic reviews. Microcosting in a large university hospital was applied to calculate cost vectors. The expected mean lifetime cost of patients undergoing 3DCRT, IMRT and HF-IMRT were 7,160 euros, 6,831 euros and 6,019 euros respectively. The expected quality-adjusted life years (QALYs) were 5.753 for 3DCRT, 5.956 for IMRT and 5.957 for HF-IMRT. Compared to 3DCRT, both IMRT and HF-IMRT resulted in more health gains at a lower cost. It can be concluded that high-dose IMRT is not only cost-effective compared to the conventional dose 3DCRT but, when used with a hypofractionation scheme, it has great cost-saving potential for the public payer and may improve access to radiation therapy for patients.

Keywords: cost-effectiveness analysis; hypofractionation; prostate cancer; radiotherapy.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Aged
  • Cost-Benefit Analysis
  • Female
  • Health Resources / economics
  • Health Resources / statistics & numerical data
  • Humans
  • Male
  • Markov Chains
  • Prostatic Neoplasms / economics*
  • Prostatic Neoplasms / radiotherapy*
  • Quality-Adjusted Life Years
  • Radiotherapy, Conformal / adverse effects
  • Radiotherapy, Conformal / economics
  • Radiotherapy, Conformal / methods
  • Radiotherapy, Intensity-Modulated / adverse effects
  • Radiotherapy, Intensity-Modulated / economics
  • Radiotherapy, Intensity-Modulated / methods
  • Risk Factors