Mathilda L Bongers1, Veerle M H Coupé2, Dirk De Ruysscher3, Cary Oberije4, Philippe Lambin4, Carin A Uyl-de Groot5, Cornelia A Uyl-de Groot. 1. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: ml.bongers@vumc.nl. 2. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. 3. Radiation Oncology University Hospitals Leuven/KU Leuven, Leuven, Belgium; Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands. 4. Department of Radiation Oncology, GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands. 5. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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.
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 NSCLCpatients 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.
Authors: Mathilda L Bongers; Dirk de Ruysscher; Cary Oberije; Philippe Lambin; Carin A Uyl-de Groot; V M H Coupé Journal: Med Decis Making Date: 2015-03-02 Impact factor: 2.583