Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients
Abstract Background Prior cost-effectiveness studies of post-mastectomy radiotherapy (PMRT) only compared conventional radiotherapy versus no radiotherapy and only considered tumor control. The goal of this study was to perform cost-effectiveness analyses of standard of care (SOC) and advanced PMRT...
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| Format: | Article |
| Language: | English |
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BMC
2020-08-01
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| Series: | Cost Effectiveness and Resource Allocation |
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| Online Access: | http://link.springer.com/article/10.1186/s12962-020-00222-y |
| _version_ | 1818410390086746112 |
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| author | Yibo Xie Beibei Guo Rui Zhang |
| author_facet | Yibo Xie Beibei Guo Rui Zhang |
| author_sort | Yibo Xie |
| collection | DOAJ |
| description | Abstract Background Prior cost-effectiveness studies of post-mastectomy radiotherapy (PMRT) only compared conventional radiotherapy versus no radiotherapy and only considered tumor control. The goal of this study was to perform cost-effectiveness analyses of standard of care (SOC) and advanced PMRT techniques including intensity-modulated radiotherapy (IMRT), standard volumetric modulated arc therapy (STD-VMAT), non-coplanar VMAT (NC-VMAT), multiple arc VMAT (MA-VMAT), Tomotherapy (TOMO), mixed beam therapy (MIXED), and intensity-modulated proton therapy (IMPT). Methods Using a Markov model, we estimated the cost-effectiveness of various techniques over 15 years. A cohort of women (55-year-old) was simulated in the model, and radiogenic side effects were considered. Transition probabilities, utilities, and costs for each health state were obtained from literature and Medicare data. Model outcomes include quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER). Results For the patient cohort, STD-VMAT has an ICER of $32,617/QALY relative to SOC; TOMO is dominated by STD-VMAT; IMRT has an ICER of $19,081/QALY relative to STD-VMAT; NC-VMAT, MA-VMAT, MIXED are dominated by IMRT; IMPT has an ICER of $151,741/QALY relative to IMRT. One-way analysis shows that the probability of cardiac toxicity has the most significant impact on the model outcomes. The probability sensitivity analyses show that all advanced PMRT techniques are more cost-effective than SOC at a willingness-to-pay (WTP) threshold of $100,000/QALY, while almost none of the advanced techniques is more cost-effective than SOC at a WTP threshold of $50,000/QALY. Conclusion Advanced PMRT techniques are more cost-effective for breast cancer patients at a WTP threshold of $100,000/QALY, and IMRT might be a cost-effective option for PMRT patients. |
| first_indexed | 2024-12-14T10:14:45Z |
| format | Article |
| id | doaj.art-aa2fb99d0d2d4c23b601b0414ebf6bbc |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-12-14T10:14:45Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-aa2fb99d0d2d4c23b601b0414ebf6bbc2022-12-21T23:06:54ZengBMCCost Effectiveness and Resource Allocation1478-75472020-08-011811710.1186/s12962-020-00222-yCost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patientsYibo Xie0Beibei Guo1Rui Zhang2Medical Physics Program, Department of Physics and Astronomy, Louisiana State UniversityDepartment of Experimental Statistics, Louisiana State UniversityMedical Physics Program, Department of Physics and Astronomy, Louisiana State UniversityAbstract Background Prior cost-effectiveness studies of post-mastectomy radiotherapy (PMRT) only compared conventional radiotherapy versus no radiotherapy and only considered tumor control. The goal of this study was to perform cost-effectiveness analyses of standard of care (SOC) and advanced PMRT techniques including intensity-modulated radiotherapy (IMRT), standard volumetric modulated arc therapy (STD-VMAT), non-coplanar VMAT (NC-VMAT), multiple arc VMAT (MA-VMAT), Tomotherapy (TOMO), mixed beam therapy (MIXED), and intensity-modulated proton therapy (IMPT). Methods Using a Markov model, we estimated the cost-effectiveness of various techniques over 15 years. A cohort of women (55-year-old) was simulated in the model, and radiogenic side effects were considered. Transition probabilities, utilities, and costs for each health state were obtained from literature and Medicare data. Model outcomes include quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER). Results For the patient cohort, STD-VMAT has an ICER of $32,617/QALY relative to SOC; TOMO is dominated by STD-VMAT; IMRT has an ICER of $19,081/QALY relative to STD-VMAT; NC-VMAT, MA-VMAT, MIXED are dominated by IMRT; IMPT has an ICER of $151,741/QALY relative to IMRT. One-way analysis shows that the probability of cardiac toxicity has the most significant impact on the model outcomes. The probability sensitivity analyses show that all advanced PMRT techniques are more cost-effective than SOC at a willingness-to-pay (WTP) threshold of $100,000/QALY, while almost none of the advanced techniques is more cost-effective than SOC at a WTP threshold of $50,000/QALY. Conclusion Advanced PMRT techniques are more cost-effective for breast cancer patients at a WTP threshold of $100,000/QALY, and IMRT might be a cost-effective option for PMRT patients.http://link.springer.com/article/10.1186/s12962-020-00222-yCost effectiveness analysisPost-mastectomyBreast cancerRadiotherapy |
| spellingShingle | Yibo Xie Beibei Guo Rui Zhang Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients Cost Effectiveness and Resource Allocation Cost effectiveness analysis Post-mastectomy Breast cancer Radiotherapy |
| title | Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients |
| title_full | Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients |
| title_fullStr | Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients |
| title_full_unstemmed | Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients |
| title_short | Cost-effectiveness analysis of advanced radiotherapy techniques for post-mastectomy breast cancer patients |
| title_sort | cost effectiveness analysis of advanced radiotherapy techniques for post mastectomy breast cancer patients |
| topic | Cost effectiveness analysis Post-mastectomy Breast cancer Radiotherapy |
| url | http://link.springer.com/article/10.1186/s12962-020-00222-y |
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