Johnna Perdrizet1, David D'Souza2, Julia Skliarenko3, Michelle Ang4, Lisa Barbera5, Eric Gutierrez4, Ananth Ravi6, Kari Tanderup7, Padraig Warde4, Kelvin Chan8, Wanrudee Isaranuwatchai9, Michael Milosevic10. 1. St. Michael's Hospital, Centre for Excellence in Economic Analysis Research, Toronto, Ontario, Canada. 2. London Health Sciences Centre, London, Ontario, Canada. 3. South Muskoka Regional Cancer Program, Barrie, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada. 4. Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada. 5. Tom Baker Cancer Centre, Calgary, Alberta, Canada. 6. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre and Sunnybrook Hospital, Toronto, Ontario, Canada. 7. Aarhus University Hospital, Department of Oncology, Aarhus, Denmark. 8. Odette Cancer Centre and Sunnybrook Hospital, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada. 9. St. Michael's Hospital, Centre for Excellence in Economic Analysis Research, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 10. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada. Electronic address: mike.milosevic@rmp.uhn.ca.
Abstract
PURPOSE: The standard treatment for locally advanced cervical cancer is external beam radiation therapy and concurrent cisplatin followed by brachytherapy. Traditionally, 2-dimensional brachytherapy (2DBT) or computed tomography guided brachytherapy (CTgBT) has been used, but magnetic resonance guided brachytherapy (MRgBT) improves clinical outcomes and has become the new standard of care. This cost-utility analysis was undertaken to compare MRgBT to CTgBT and 2DBT. METHODS AND MATERIALS: A Markov model was constructed to evaluate the cost-utility from the perspective of the public health care payer in Ontario. Treatment effectiveness, expressed as quality-adjusted life years, and costs, expressed in 2016 Canadian dollars, were evaluated for MRgBT, CTgBT, and 2DBT. Results were reported as incremental cost-effectiveness ratios for all patients and separately for low and high-risk subgroups. Sensitivity analyses were performed to assess the impact of uncertainty in model parameters. RESULTS: MRgBT improved tumor control, reduced side effects, and was less costly compared with either CTgBT or 2DBT for all patients and in low- and high-risk prognostic subgroups separately. Sensitivity analysis supported the robustness of the findings and identified the cost of treating cancer recurrence to be the single most influential model parameter. CONCLUSIONS: MRgBT is more effective and less costly than CTgBT or 2DBT by avoiding downstream costs of treating cancer recurrence and managing side effects. These findings will assist health care providers and policymakers with future infrastructure and human resource planning to ensure optimal care of women with this disease.
PURPOSE: The standard treatment for locally advanced cervical cancer is external beam radiation therapy and concurrent cisplatin followed by brachytherapy. Traditionally, 2-dimensional brachytherapy (2DBT) or computed tomography guided brachytherapy (CTgBT) has been used, but magnetic resonance guided brachytherapy (MRgBT) improves clinical outcomes and has become the new standard of care. This cost-utility analysis was undertaken to compare MRgBT to CTgBT and 2DBT. METHODS AND MATERIALS: A Markov model was constructed to evaluate the cost-utility from the perspective of the public health care payer in Ontario. Treatment effectiveness, expressed as quality-adjusted life years, and costs, expressed in 2016 Canadian dollars, were evaluated for MRgBT, CTgBT, and 2DBT. Results were reported as incremental cost-effectiveness ratios for all patients and separately for low and high-risk subgroups. Sensitivity analyses were performed to assess the impact of uncertainty in model parameters. RESULTS: MRgBT improved tumor control, reduced side effects, and was less costly compared with either CTgBT or 2DBT for all patients and in low- and high-risk prognostic subgroups separately. Sensitivity analysis supported the robustness of the findings and identified the cost of treating cancer recurrence to be the single most influential model parameter. CONCLUSIONS: MRgBT is more effective and less costly than CTgBT or 2DBT by avoiding downstream costs of treating cancer recurrence and managing side effects. These findings will assist health care providers and policymakers with future infrastructure and human resource planning to ensure optimal care of women with this disease.
Authors: Vonetta M Williams; Jenna M Kahn; Nikhil G Thaker; Sushil Beriwal; Paul L Nguyen; Douglas Arthur; Daniel Petereit; Brandon A Dyer Journal: Adv Radiat Oncol Date: 2020-11-06