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MODEL-BASED COST-EFFECTIVENESS OF CONVENTIONAL AND INNOVATIVE CHEMO-RADIATION IN LUNG CANCER

Published online by Cambridge University Press:  10 November 2017

Mathilda L. Bongers ,
Dirk de Ruysscher ,
Cary Oberije ,
Philippe Lambin ,
Carin A. Uyl-de Groot ,
José Belderbos  and
Veerle M.H. Coupé
Mathilda L. Bongers
Affiliation:
Department of Epidemiology and Biostatistics, VU University Medical Center
Dirk de Ruysscher
Affiliation:
Department of Radiation Oncology, University Hospitals Leuven/KU Leuven
Cary Oberije
Affiliation:
Department of Radiation Oncology (MAASTRO), GROW Research Institute, Maastricht University Medical Centre
Philippe Lambin
Affiliation:
Department of Radiation Oncology (MAASTRO), GROW Research Institute, Maastricht University Medical Centre
Carin A. Uyl-de Groot
Affiliation:
Institute for Medical Technology Assessment, Erasmus University Rotterdam
José Belderbos
Affiliation:
Department of Radiotherapy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital
Veerle M.H. Coupé
Affiliation:
Department of Epidemiology and Biostatistics, VU University Medical Centerv.coupe@vumc.nl
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Abstract

Introduction: Optimizing radiotherapy with or without chemotherapy through advanced imaging and accelerated radiation schemes shows promising results in locally advanced non–small-cell lung cancer (NSCLC). This study compared the cost-effectiveness of positron emission tomography-computed tomography based isotoxic accelerated sequential chemo-radiation (SRT2) and concurrent chemo-radiation with daily low-dose cisplatin (CRT2) with standard sequential (SRT1) and concurrent chemo-radiation (CRT1).

Methods: We used an externally validated mathematical model to simulate the four treatment strategies. The model was built using data from 200 NSCLC patients treated with curative sequential chemo-radiation. For concurrent strategies, data from a meta-analysis and a single study were included in the model. Costs, utilities, and resource use estimates were obtained from literature. Primary outcomes were the incremental cost-effectiveness and cost-utility ratio (ICUR) of each strategy. Scenario analyses were carried out to investigate the impact of uncertainty.

Results: Total undiscounted costs and quality-adjusted life-years (QALYs) for SRT1, CRT1, SRT2, and CRT2 were EUR 17,288, EUR 18,756, EUR 19,072, EUR 17,360 and QALYs 1.10, 1.15, 1.40, and 1.40, respectively. Compared with SRT1, the ICURs were EUR 38,024/QALY for CRT1, EUR 6,249/QALY for SRT2, and EUR 346/QALY for CRT2. CRT2 was highly cost-effective compared with SRT1. Moreover, CRT2 was more effective and less costly than CRT1 and SRT2. Therefore, these strategies were dominated by CRT2.

Conclusion: Optimized sequential and concurrent chemo-radiation strategies are more effective and cost-effective than the current conventional sequential and concurrent strategies. Concurrent chemo-radiation with a daily low dose cisplatin regimen is the most cost-effective treatment option for locally advanced inoperable NSCLC patients.

Keywords

Cost-effectivenessModelingChemo-radiationRadiotherapyLung cancer
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 6 , 2017 , pp. 681 - 690
Copyright
Copyright © Cambridge University Press 2017 

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