Damien C Weber1, Coen W Hurkmans2, Christos Melidis3, Wilfried Budach4, Johannes H Langendijk5, Lester J Peters6, Vincent Grégoire7, Philippe Maingon8, Christophe Combescure9. 1. Center for Proton Therapy, Paul Scherrer Institute, Switzerland; QA Strategic Committee and Team, EORTC HQ, Brussels, Belgium. Electronic address: damien.weber@psi.ch. 2. QA Strategic Committee and Team, EORTC HQ, Brussels, Belgium; Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: coen.hurkmans@catharinaziekenhuis.nl. 3. QA Strategic Committee and Team, EORTC HQ, Brussels, Belgium. Electronic address: christos.melidis@eortc.be. 4. Heinrich-Heine Universitätsklinik Düsseldorf, Germany. Electronic address: Wilfried.Budach@med.uni-duesseldorf.de. 5. University Medical Center Groningen, The Netherlands. Electronic address: j.a.langendijk@umcg.nl. 6. Peter MacCallum Cancer Centre, Melbourne, Australia. Electronic address: Lester.Peters@petermac.org. 7. St. Luc University Hospital, Brussels, Belgium. Electronic address: vincent.gregoire@imre.ucl.ac.be. 8. Radiation Oncology, Centre Georges-François-Leclerc, Dijon, France. Electronic address: pmaingon@dijon.fnclcc.fr. 9. Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals of Geneva, Switzerland. Electronic address: christophe.combescure@hcuge.ch.
Abstract
INTRODUCTION: One of the goals of Quality Assurance in Radiotherapy (QART) is to reduce the variability and uncertainties related to treatment planning and beam delivery. The purpose of this study was to assess the outcome impact and cost-effectiveness (CE) of various QART levels for a head and neck (H&N) cancer study. MATERIALS AND METHODS: QART levels were defined as: basic QART with a dummy run (level 2), level 2 plus prospective Individual Case Reviews (ICRs) for 15% of patients (level 3) and level 2 plus prospective ICRs for all patients (level 4). The follow-up of patients was modeled using a multi-state model with parameters derived from EORTC, TROG and RTOG prospective studies. Individual patient data, linking QART results with outcome, were retrieved from the TROG database. Results for each QART level were expressed as percentage of mortality and local failure at 5 years. RESULTS: Quality-of-life-adjusted and recurrence-free survival increased with increasing QART levels. The increase of all these metrics was more sizeable with an increased QART level from 2 or 3 to 4. The estimated quality-adjusted-life-years (QALYs) for an increase of QART levels of 3-4 and 2-4 were 0.09 and 0.15, respectively. The incremental CE ratio was €5525 and €3659 Euros per QALY for these QART levels. Compared to QART level 2 or 3, level 4 was cost-effective. CONCLUSIONS: Increasing QART levels resulted in better patient outcome in this simulated study. The increased complexity of the QART program was also cost-effective.
INTRODUCTION: One of the goals of Quality Assurance in Radiotherapy (QART) is to reduce the variability and uncertainties related to treatment planning and beam delivery. The purpose of this study was to assess the outcome impact and cost-effectiveness (CE) of various QART levels for a head and neck (H&N) cancer study. MATERIALS AND METHODS: QART levels were defined as: basic QART with a dummy run (level 2), level 2 plus prospective Individual Case Reviews (ICRs) for 15% of patients (level 3) and level 2 plus prospective ICRs for all patients (level 4). The follow-up of patients was modeled using a multi-state model with parameters derived from EORTC, TROG and RTOG prospective studies. Individual patient data, linking QART results with outcome, were retrieved from the TROG database. Results for each QART level were expressed as percentage of mortality and local failure at 5 years. RESULTS: Quality-of-life-adjusted and recurrence-free survival increased with increasing QART levels. The increase of all these metrics was more sizeable with an increased QART level from 2 or 3 to 4. The estimated quality-adjusted-life-years (QALYs) for an increase of QART levels of 3-4 and 2-4 were 0.09 and 0.15, respectively. The incremental CE ratio was €5525 and €3659 Euros per QALY for these QART levels. Compared to QART level 2 or 3, level 4 was cost-effective. CONCLUSIONS: Increasing QART levels resulted in better patient outcome in this simulated study. The increased complexity of the QART program was also cost-effective.
Authors: Catharine H Clark; Edwin G A Aird; Steve Bolton; Elizabeth A Miles; Andrew Nisbet; Julia A D Snaith; Russell A S Thomas; Karen Venables; David I Thwaites Journal: Br J Radiol Date: 2015-09-02 Impact factor: 3.039
Authors: Jean M Moran; Andrea Molineu; Jon J Kruse; Mark Oldham; Robert Jeraj; James M Galvin; Jatinder R Palta; Arthur J Olch Journal: J Appl Clin Med Phys Date: 2018-06-29 Impact factor: 2.102
Authors: Sweet Ping Ng; Brandon A Dyer; Jayashree Kalpathy-Cramer; Abdallah Sherif Radwan Mohamed; Musaddiq J Awan; G Brandon Gunn; Jack Phan; Mark Zafereo; J Matthew Debnam; Carol M Lewis; Rivka R Colen; Michael E Kupferman; Nandita Guha-Thakurta; Guadalupe Canahuate; G Elisabeta Marai; David Vock; Bronwyn Hamilton; John Holland; Carlos E Cardenas; Stephen Lai; David Rosenthal; Clifton David Fuller Journal: Clin Transl Radiat Oncol Date: 2018-08-02