X Melody Qu1, Yujie Chen2, Gregory S Zaric3, Suresh Senan4, Robert A Olson5, Stephen Harrow6, Ava John-Baptiste1, Stewart Gaede7, Liam A Mulroy8, Devin Schellenberg9, Sashendra Senthi10, Anand Swaminath11, Neil Kopek12, Mitchell Liu13, Andrew Warner7, George B Rodrigues1, David A Palma1, Alexander V Louie14. 1. London Health Sciences Centre, London, Canada; Schulich School of Medicine & Dentistry, Western University, London, Canada. 2. Schulich School of Medicine & Dentistry, Western University, London, Canada. 3. Schulich School of Medicine & Dentistry, Western University, London, Canada; Ivey Business School, Western University, London, Canada. 4. Amsterdam University Medical Center, Vrije Universiteit Medical Center, Amsterdam, Netherlands. 5. British Columbia Cancer, Centre for the North, Prince George, Canada. 6. Beatson West of Scotland Cancer Centre, Glasgow, Scotland. 7. London Health Sciences Centre, London, Canada. 8. Nova Scotia Cancer Centre, Halifax, Canada. 9. British Columbia Cancer, Surrey Centre, Surrey, Canada. 10. Alfred Health Radiation Oncology, Melbourne, Australia. 11. Juravinski Cancer Centre, Hamilton, Canada. 12. McGill University Health Centre, Montreal, Canada. 13. British Columbia Cancer, Vancouver Centre, Vancouver, Canada. 14. London Health Sciences Centre, London, Canada; Schulich School of Medicine & Dentistry, Western University, London, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada. Electronic address: alexander.louie@sunnybrook.ca.
Abstract
PURPOSE: The phase 2 randomized study SABR-COMET demonstrated that in patients with controlled primary tumors and 1 to 5 oligometastatic lesions, SABR was associated with improved progression-free survival (PFS) compared with standard of care (SoC), but with higher costs and treatment-related toxicities. The aim of this study was to assess the cost-effectiveness of SABR versus SoC in this setting. METHODS AND MATERIALS: A Markov model was constructed to perform a cost-utility analysis from the Canadian health care system perspective. Utility values and transition probabilities were derived from individual-level data from the SABR-COMET trial. One-way, 2-way, and probabilistic sensitivity analyses were performed. Costs were expressed in 2018 CAD. A separate analysis based on US payer's perspective was performed. An incremental cost-effectiveness ratio (ICER) at a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was used. RESULTS: In the base case scenario, SABR was cost-effective at an ICER of $37,157 per QALY gained. This finding was most sensitive to the number of metastatic lesions treated with SABR (ICER: $28,066 per QALY for 2, increasing to $64,429 per QALY for 5), difference in chemotherapy use (ICER: $27,173-$53,738 per QALY), and PFS hazard ratio (HR) between strategies (ICER: $31,548-$53,273 per QALY). Probabilistic sensitivity analysis revealed that SABR was cost-effective in 97% of all iterations. Two-way sensitivity analysis demonstrated a nonlinear relationship between the number of lesions and the PFS HR. To maintain cost-effectiveness for each additional metastasis, the HR must decrease by approximately 0.047. The US cost analysis yielded similar results, with an ICER of $54,564 (2018 USD per QALY) for SABR. CONCLUSIONS:SABR is cost-effective for patients with 1 to 5 oligometastatic lesions compared with SoC.
RCT Entities:
PURPOSE: The phase 2 randomized study SABR-COMET demonstrated that in patients with controlled primary tumors and 1 to 5 oligometastatic lesions, SABR was associated with improved progression-free survival (PFS) compared with standard of care (SoC), but with higher costs and treatment-related toxicities. The aim of this study was to assess the cost-effectiveness of SABR versus SoC in this setting. METHODS AND MATERIALS: A Markov model was constructed to perform a cost-utility analysis from the Canadian health care system perspective. Utility values and transition probabilities were derived from individual-level data from the SABR-COMET trial. One-way, 2-way, and probabilistic sensitivity analyses were performed. Costs were expressed in 2018 CAD. A separate analysis based on US payer's perspective was performed. An incremental cost-effectiveness ratio (ICER) at a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was used. RESULTS: In the base case scenario, SABR was cost-effective at an ICER of $37,157 per QALY gained. This finding was most sensitive to the number of metastatic lesions treated with SABR (ICER: $28,066 per QALY for 2, increasing to $64,429 per QALY for 5), difference in chemotherapy use (ICER: $27,173-$53,738 per QALY), and PFS hazard ratio (HR) between strategies (ICER: $31,548-$53,273 per QALY). Probabilistic sensitivity analysis revealed that SABR was cost-effective in 97% of all iterations. Two-way sensitivity analysis demonstrated a nonlinear relationship between the number of lesions and the PFS HR. To maintain cost-effectiveness for each additional metastasis, the HR must decrease by approximately 0.047. The US cost analysis yielded similar results, with an ICER of $54,564 (2018 USD per QALY) for SABR. CONCLUSIONS:SABR is cost-effective for patients with 1 to 5 oligometastatic lesions compared with SoC.
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