Leif-Erik D Schumacher1, Alan Dal Pra1, Sarah E Hoffe2, Eric A Mellon3. 1. Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States. 2. Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States. 3. Radiation Oncology and Bioengineering, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States.
Abstract
OBJECTIVE: To determine the toxicity reduction required to justify the added costs of MRI-guided radiotherapy (MR-IGRT) over CT-based image guided radiotherapy (CT-IGRT) for the treatment of localized prostate cancer. METHODS: The costs of delivering prostate cancer radiotherapy with MR-IGRT and CT-IGRT in conventional 39 fractions and stereotactic body radiotherapy (SBRT) 5 fractions schedules were determined using literature values and cost accounting from two institutions. Gastrointestinal and genitourinary toxicity rates associated with CT-IGRT were summarized from 20 studies. Toxicity-related costs and utilities were obtained from literature values and cost databases. Markov modeling was used to determine the savings per patient for every 1% relative reduction in acute and chronic toxicities by MR-IGRT over 15 years. The costs and quality adjusted life years (QALYs) saved with toxicity reduction were juxtaposed with the cost increase of MR-IGRT to determine toxicity reduction thresholds for cost-effectiveness. One way sensitivity analyses were performed. Standard $100,000 and $50,000 per QALY ratios were used. RESULTS: The added cost of MR-IGRT was $1,459 per course of SBRT and $10,129 per course of conventionally fractionated radiotherapy. Relative toxicity reductions of 7 and 14% are required for SBRT to be cost-effective using $100,000 and $50,000 per QALY, respectively. Conventional radiotherapy requires relative toxicity reductions of 50 and 94% to be cost-effective. CONCLUSION: From a healthcare perspective, MR-IGRT can reasonably be expected to be cost-effective. Hypofractionated schedules, such a five fraction SBRT, are most likely to be cost-effective as they require only slight reductions in toxicity (7-14%). ADVANCES IN KNOWLEDGE: This is the first detailed economic assessment of MR-IGRT, and it suggests that MR-IGRT can be cost-effective for prostate cancer treatment through toxicity reduction alone.
OBJECTIVE: To determine the toxicity reduction required to justify the added costs of MRI-guided radiotherapy (MR-IGRT) over CT-based image guided radiotherapy (CT-IGRT) for the treatment of localized prostate cancer. METHODS: The costs of delivering prostate cancer radiotherapy with MR-IGRT and CT-IGRT in conventional 39 fractions and stereotactic body radiotherapy (SBRT) 5 fractions schedules were determined using literature values and cost accounting from two institutions. Gastrointestinal and genitourinary toxicity rates associated with CT-IGRT were summarized from 20 studies. Toxicity-related costs and utilities were obtained from literature values and cost databases. Markov modeling was used to determine the savings per patient for every 1% relative reduction in acute and chronic toxicities by MR-IGRT over 15 years. The costs and quality adjusted life years (QALYs) saved with toxicity reduction were juxtaposed with the cost increase of MR-IGRT to determine toxicity reduction thresholds for cost-effectiveness. One way sensitivity analyses were performed. Standard $100,000 and $50,000 per QALY ratios were used. RESULTS: The added cost of MR-IGRT was $1,459 per course of SBRT and $10,129 per course of conventionally fractionated radiotherapy. Relative toxicity reductions of 7 and 14% are required for SBRT to be cost-effective using $100,000 and $50,000 per QALY, respectively. Conventional radiotherapy requires relative toxicity reductions of 50 and 94% to be cost-effective. CONCLUSION: From a healthcare perspective, MR-IGRT can reasonably be expected to be cost-effective. Hypofractionated schedules, such a five fraction SBRT, are most likely to be cost-effective as they require only slight reductions in toxicity (7-14%). ADVANCES IN KNOWLEDGE: This is the first detailed economic assessment of MR-IGRT, and it suggests that MR-IGRT can be cost-effective for prostate cancer treatment through toxicity reduction alone.
Authors: James B Yu; Laura D Cramer; Jeph Herrin; Pamela R Soulos; Arnold L Potosky; Cary P Gross Journal: J Clin Oncol Date: 2014-03-10 Impact factor: 44.544
Authors: William C Jackson; Jessica Silva; Holly E Hartman; Robert T Dess; Amar U Kishan; Whitney H Beeler; Laila A Gharzai; Elizabeth M Jaworski; Rohit Mehra; Jason W D Hearn; Todd M Morgan; Simpa S Salami; Matthew R Cooperberg; Brandon A Mahal; Payal D Soni; Samuel Kaffenberger; Paul L Nguyen; Neil Desai; Felix Y Feng; Zachary S Zumsteg; Daniel E Spratt Journal: Int J Radiat Oncol Biol Phys Date: 2019-04-06 Impact factor: 7.038
Authors: Hamid Raziee; Fabio Y Moraes; Jure Murgic; Melvin L K Chua; Melania Pintilie; Peter Chung; Cynthia Ménard; Andrew Bayley; Mary Gospodarowicz; Padraig Warde; Tim Craig; Charles Catton; Robert G Bristow; David A Jaffray; Alejandro Berlin Journal: Radiother Oncol Date: 2017-04-20 Impact factor: 6.280
Authors: Soumon Rudra; Naomi Jiang; Stephen A Rosenberg; Jeffrey R Olsen; Michael C Roach; Leping Wan; Lorraine Portelance; Eric A Mellon; Anna Bruynzeel; Frank Lagerwaard; Michael F Bassetti; Parag J Parikh; Percy P Lee Journal: Cancer Med Date: 2019-04-01 Impact factor: 4.452
Authors: Abdallah S R Mohamed; Houda Bahig; Michalis Aristophanous; Pierre Blanchard; Mona Kamal; Yao Ding; Carlos E Cardenas; Kristy K Brock; Stephen Y Lai; Katherine A Hutcheson; Jack Phan; Jihong Wang; Geoffrey Ibbott; Refaat E Gabr; Ponnada A Narayana; Adam S Garden; David I Rosenthal; G Brandon Gunn; Clifton D Fuller Journal: Clin Transl Radiat Oncol Date: 2018-05-05
Authors: Neil R Parikh; Mary Ann Clark; Parashar Patel; Kayla Kafka-Peterson; Lalaine Zaide; Ting Martin Ma; Michael L Steinberg; Minsong Cao; Ann C Raldow; James Lamb; Amar U Kishan Journal: Appl Radiat Oncol Date: 2021-10-05
Authors: Paul J Keall; Caterina Brighi; Carri Glide-Hurst; Gary Liney; Paul Z Y Liu; Suzanne Lydiard; Chiara Paganelli; Trang Pham; Shanshan Shan; Alison C Tree; Uulke A van der Heide; David E J Waddington; Brendan Whelan Journal: Nat Rev Clin Oncol Date: 2022-04-19 Impact factor: 65.011
Authors: David Cantarero-Prieto; Javier Lera; Paloma Lanza-Leon; Marina Barreda-Gutierrez; Vicente Guillem-Porta; Luis Castelo-Branco; Jose M Martin-Moreno Journal: Cancers (Basel) Date: 2022-08-24 Impact factor: 6.575
Authors: Alessandra Castelluccia; Pierpaolo Mincarone; Maria Rosaria Tumolo; Saverio Sabina; Riccardo Colella; Antonella Bodini; Francesco Tramacere; Maurizio Portaluri; Carlo Giacomo Leo Journal: Int J Environ Res Public Health Date: 2022-08-30 Impact factor: 4.614