L Andy Chen1, Jaewhan Kim2, Kenneth Boucher3, Breanne Terakedis1, Britney Williams4, Nancy A Nickman5, David K Gaffney1. 1. Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT, USA. 2. Department of Family & Preventive Medicine, University of Utah, Salt Lake City, UT, USA. 3. Study Design and Biostatistics Center, Division of Epidemiology and Public Health, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA. 4. School of Medicine, University of Utah, Salt Lake City, UT, USA. 5. Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA.
Abstract
OBJECTIVE: To evaluate toxicity and cost-effectiveness of intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT) in the postoperative treatment of uterine and cervical cancer. METHODS: Between 2000 and 2012, eighty patients at our institution received post-hysterectomy 3DCRT (46) or IMRT (34) for uterine or cervical cancer. Baseline characteristics, outcome, and ≥CTCAE grade 2 toxicities were compared between the two groups. Predictors of toxicity-free survival were identified. A decision analysis model was designed to capture individual health states at 1, 2, and 3 years after treatment. Micro-costing technique and estimated quality-adjusted life years (QALYs) were used to calculate incremental cost-effectiveness ratio (ICER). RESULTS: Utilization of IMRT increased from 25% (2005-2007) to 75% (2008-2012). Recurrence-free and overall survival rates were not different between the two groups. Toxicity rates were reduced with IMRT versus 3DCRT (HR 0.42, p=0.04). Women who received IMRT had numerically lower rates of late gastrointestinal and genitourinary toxicity and significantly lower rates of late overall toxicity at 3 years (16% vs. 45%, p=0.04). On univariate analysis, IMRT was associated with decreased late toxicity (HR 0.43, p=0.04). Treatment costs were higher and toxicity costs were lower with IMRT. IMRT had an ICER of $235,233 (year 1), $114,270 (year 2), and $75,555 (year 3) per QALY gained. CONCLUSION: IMRT is associated with reduced late overall toxicity compared to 3DCRT without compromising clinical outcome. IMRT is not cost-effective during the early chronic toxicity phase, but it becomes more cost-effective over time.
OBJECTIVE: To evaluate toxicity and cost-effectiveness of intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT) in the postoperative treatment of uterine and cervical cancer. METHODS: Between 2000 and 2012, eighty patients at our institution received post-hysterectomy 3DCRT (46) or IMRT (34) for uterine or cervical cancer. Baseline characteristics, outcome, and ≥CTCAE grade 2 toxicities were compared between the two groups. Predictors of toxicity-free survival were identified. A decision analysis model was designed to capture individual health states at 1, 2, and 3 years after treatment. Micro-costing technique and estimated quality-adjusted life years (QALYs) were used to calculate incremental cost-effectiveness ratio (ICER). RESULTS: Utilization of IMRT increased from 25% (2005-2007) to 75% (2008-2012). Recurrence-free and overall survival rates were not different between the two groups. Toxicity rates were reduced with IMRT versus 3DCRT (HR 0.42, p=0.04). Women who received IMRT had numerically lower rates of late gastrointestinal and genitourinary toxicity and significantly lower rates of late overall toxicity at 3 years (16% vs. 45%, p=0.04). On univariate analysis, IMRT was associated with decreased late toxicity (HR 0.43, p=0.04). Treatment costs were higher and toxicity costs were lower with IMRT. IMRT had an ICER of $235,233 (year 1), $114,270 (year 2), and $75,555 (year 3) per QALY gained. CONCLUSION: IMRT is associated with reduced late overall toxicity compared to 3DCRT without compromising clinical outcome. IMRT is not cost-effective during the early chronic toxicity phase, but it becomes more cost-effective over time.
Authors: Ann H Klopp; Anamaria R Yeung; Snehal Deshmukh; Karen M Gil; Lari Wenzel; Shannon N Westin; Kent Gifford; David K Gaffney; William Small; Spencer Thompson; Desiree E Doncals; Guilherme H C Cantuaria; Brian P Yaremko; Amy Chang; Vijayananda Kundapur; Dasarahally S Mohan; Michael L Haas; Yong Bae Kim; Catherine L Ferguson; Stephanie L Pugh; Lisa A Kachnic; Deborah W Bruner Journal: J Clin Oncol Date: 2018-07-10 Impact factor: 44.544
Authors: Minal S Kale; Grace Mhango; Marcelo Bonomi; Alex Federman; Keith Sigel; Kenneth E Rosenzweig; Juan P Wisnivesky Journal: Ann Am Thorac Soc Date: 2016-09
Authors: Loren K Mell; Ronghui Xu; Catheryn M Yashar; Michael T McHale; John P Einck; Jyoti Mayadev; Euyhyun Lee; Pratibha Binder; Dominique Rash; Ramez Eskander; Elena S Heide; Steven C Plaxe; Arno J Mundt; Cheryl C Saenz Journal: Int J Radiat Oncol Biol Phys Date: 2020-04-22 Impact factor: 8.013