OBJECTIVE: We sought to compare the relative cost-effectiveness of surgical intervention and stereotactic body radiation therapy in high risk patients with clinical stage I lung cancer (non-small cell lung cancer). METHODS: We compared patients chosen for surgical intervention or SBRT for clinical stage I non-small cell lung cancer. Propensity score matching was used to adjust estimated treatment hazard ratios for the confounding effects of age, comorbidity index, and clinical stage. We assumed that Medicare-allowable charges were $15,034 for surgical intervention and $13,964 for stereotactic body radiation therapy. The incremental cost-effectiveness ratio was estimated as the cost per life year gained over the patient's remaining lifetime by using a decision model. RESULTS: Fifty-seven patients in each arm were selected by means of propensity score matching. Median survival with surgical intervention was 4.1 years, and 4-year survival was 51.4%. With stereotactic body radiation therapy, median survival was 2.9 years, and 4-year survival was 30.1%. Cause-specific survival was identical between the 2 groups, and the difference in overall survival was not statistically significant. For decision modeling, stereotactic body radiation therapy was estimated to have a mean expected survival of 2.94 years at a cost of $14,153 and mean expected survival with surgical intervention was 3.39 years at a cost of $17,629, for an incremental cost-effectiveness ratio of $7753. CONCLUSIONS: In our analysis stereotactic body radiation therapy appears to be less costly than surgical intervention in high-risk patients with early stage non-small cell lung cancer. However, surgical intervention appears to meet the standards for cost-effectiveness because of a longer expected overall survival. Should this advantage not be confirmed in other studies, the cost-effectiveness decision would be likely to change. Prospective randomized studies are necessary to strengthen confidence in these results.
OBJECTIVE: We sought to compare the relative cost-effectiveness of surgical intervention and stereotactic body radiation therapy in high risk patients with clinical stage I lung cancer (non-small cell lung cancer). METHODS: We compared patients chosen for surgical intervention or SBRT for clinical stage I non-small cell lung cancer. Propensity score matching was used to adjust estimated treatment hazard ratios for the confounding effects of age, comorbidity index, and clinical stage. We assumed that Medicare-allowable charges were $15,034 for surgical intervention and $13,964 for stereotactic body radiation therapy. The incremental cost-effectiveness ratio was estimated as the cost per life year gained over the patient's remaining lifetime by using a decision model. RESULTS: Fifty-seven patients in each arm were selected by means of propensity score matching. Median survival with surgical intervention was 4.1 years, and 4-year survival was 51.4%. With stereotactic body radiation therapy, median survival was 2.9 years, and 4-year survival was 30.1%. Cause-specific survival was identical between the 2 groups, and the difference in overall survival was not statistically significant. For decision modeling, stereotactic body radiation therapy was estimated to have a mean expected survival of 2.94 years at a cost of $14,153 and mean expected survival with surgical intervention was 3.39 years at a cost of $17,629, for an incremental cost-effectiveness ratio of $7753. CONCLUSIONS: In our analysis stereotactic body radiation therapy appears to be less costly than surgical intervention in high-risk patients with early stage non-small cell lung cancer. However, surgical intervention appears to meet the standards for cost-effectiveness because of a longer expected overall survival. Should this advantage not be confirmed in other studies, the cost-effectiveness decision would be likely to change. Prospective randomized studies are necessary to strengthen confidence in these results.
Authors: Pamela Samson; Aalok Patel; Cliff G Robinson; Daniel Morgensztern; Su-Hsin Chang; Graham A Colditz; Saiama Waqar; Traves D Crabtree; A Sasha Krupnick; Daniel Kreisel; G Alexander Patterson; Bryan F Meyers; Varun Puri Journal: Ann Thorac Surg Date: 2015-08-25 Impact factor: 4.330
Authors: Christina S Moon; Afshan A Nanji; Anat Galor; Kathryn E McCollister; Carol L Karp Journal: Ophthalmology Date: 2015-12-11 Impact factor: 12.079
Authors: Traves D Crabtree; Varun Puri; Clifford Robinson; Jeffrey Bradley; Stephen Broderick; G Alexander Patterson; Jingxia Liu; Joanne F Musick; Jennifer M Bell; Michael Yang; Bryan F Meyers Journal: J Thorac Cardiovasc Surg Date: 2014-01-02 Impact factor: 5.209
Authors: Christopher Cao; Daniel Wang; Caroline Chung; David Tian; Andreas Rimner; James Huang; David R Jones Journal: J Thorac Cardiovasc Surg Date: 2018-09-15 Impact factor: 5.209