Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer

Willem J A Witlox; Bram L T Ramaekers; Benjamin Lacas; Cecile Le Pechoux; Alexander Sun; Si-Yu Wang; Chen Hu; Mary Redman; Vincent van der Noort; Ning Li; Matthias Guckenberger; Harm van Tinteren; Lizza E L Hendriks; Harry J M Groen; Manuela A Joore; Dirk K M De Ruysscher

doi:10.1016/j.radonc.2022.02.036

Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer

Willem J A Witlox^*, Bram L T Ramaekers, Benjamin Lacas, Cecile Le Pechoux, Alexander Sun, Si-Yu Wang, Chen Hu, Mary Redman, Vincent van der Noort, Ning Li, Matthias Guckenberger, Harm van Tinteren, Lizza E L Hendriks, Harry J M Groen, Manuela A Joore, Dirk K M De Ruysscher

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

INTRODUCTION: In stage III non-small cell lung cancer (NSCLC), prophylactic cranial irradiation (PCI) reduces the brain metastases incidence and prolongs the progression-free survival without improving overall survival. PCI increases the risk of toxicity and is currently not adopted in routine care. Our objective was to assess the cost-effectiveness of PCI compared with no PCI in stage III NSCLC from a Dutch societal perspective.

METHODS: A cohort partitioned survival model was developed based on individual patient data from three randomized phase III trials (N=670). Quality-adjusted life years (QALYs) and costs were estimated over a lifetime time horizon.. A willingness-to-pay (WTP) threshold of €80,000 per QALY was adopted. Sensitivity and scenario analyses were performed to address parameter uncertainty and to explore what parameters had the greatest impact on the cost-effectiveness results.

RESULTS: PCI was more effective and costly (0.443 QALYs, €10,123) than no PCI, resulting in an incremental cost-effectiveness ratio (ICER) of €22,843 per QALY gained. The probability of PCI being cost-effective at a WTP threshold of €80,000 per QALY was 93%. The probability of PCI gaining three and six additional months of life were 76% and 56%. The scenario analysis adding durvalumab increased the ICER to €35,159 per QALY gained. Using alternative survival distributions had little impact on the ICER. Assuming fewer PCI fractions and excluding indirect costs decreased the ICER to €18,263 and €5,554 per QALY gained.

CONCLUSION: PCI is cost-effective compared to no PCI in stage III NSCLC, and could therefore, from a cost-effectiveness perspective, be considered in routine care.

Original language	English
Pages (from-to)	95-101
Number of pages	7
Journal	Radiotherapy and Oncology
Volume	170
Early online date	5 Mar 2022
DOIs	https://doi.org/10.1016/j.radonc.2022.02.036
Publication status	Published - May 2022

Keywords

CHEMORADIOTHERAPY
Cohort partitioned survival model
Cost-effectiveness analysis
HIGH-RISK
METASTASES
Prophylactic cranial irradiation
RADIATION
Stage III non-small cell lung cancer
TRIAL
TUMORS

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Witlox, W. J. A., Ramaekers, B. L. T., Lacas, B., Le Pechoux, C., Sun, A., Wang, S.-Y., Hu, C., Redman, M., van der Noort, V., Li, N., Guckenberger, M., van Tinteren, H., Hendriks, L. E. L., Groen, H. J. M., Joore, M. A., & De Ruysscher, D. K. M. (2022). Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer. Radiotherapy and Oncology, 170, 95-101. https://doi.org/10.1016/j.radonc.2022.02.036

@article{d91a0f249c6b4bea934f30064c776153,

title = "Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer",

abstract = "INTRODUCTION: In stage III non-small cell lung cancer (NSCLC), prophylactic cranial irradiation (PCI) reduces the brain metastases incidence and prolongs the progression-free survival without improving overall survival. PCI increases the risk of toxicity and is currently not adopted in routine care. Our objective was to assess the cost-effectiveness of PCI compared with no PCI in stage III NSCLC from a Dutch societal perspective.METHODS: A cohort partitioned survival model was developed based on individual patient data from three randomized phase III trials (N=670). Quality-adjusted life years (QALYs) and costs were estimated over a lifetime time horizon.. A willingness-to-pay (WTP) threshold of €80,000 per QALY was adopted. Sensitivity and scenario analyses were performed to address parameter uncertainty and to explore what parameters had the greatest impact on the cost-effectiveness results.RESULTS: PCI was more effective and costly (0.443 QALYs, €10,123) than no PCI, resulting in an incremental cost-effectiveness ratio (ICER) of €22,843 per QALY gained. The probability of PCI being cost-effective at a WTP threshold of €80,000 per QALY was 93%. The probability of PCI gaining three and six additional months of life were 76% and 56%. The scenario analysis adding durvalumab increased the ICER to €35,159 per QALY gained. Using alternative survival distributions had little impact on the ICER. Assuming fewer PCI fractions and excluding indirect costs decreased the ICER to €18,263 and €5,554 per QALY gained.CONCLUSION: PCI is cost-effective compared to no PCI in stage III NSCLC, and could therefore, from a cost-effectiveness perspective, be considered in routine care.",

keywords = "CHEMORADIOTHERAPY, Cohort partitioned survival model, Cost-effectiveness analysis, HIGH-RISK, METASTASES, Prophylactic cranial irradiation, RADIATION, Stage III non-small cell lung cancer, TRIAL, TUMORS",

author = "Witlox, {Willem J A} and Ramaekers, {Bram L T} and Benjamin Lacas and {Le Pechoux}, Cecile and Alexander Sun and Si-Yu Wang and Chen Hu and Mary Redman and {van der Noort}, Vincent and Ning Li and Matthias Guckenberger and {van Tinteren}, Harm and Hendriks, {Lizza E L} and Groen, {Harry J M} and Joore, {Manuela A} and {De Ruysscher}, {Dirk K M}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier B.V.",

year = "2022",

month = may,

doi = "10.1016/j.radonc.2022.02.036",

language = "English",

volume = "170",

pages = "95--101",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

Witlox, WJA , Ramaekers, BLT, Lacas, B, Le Pechoux, C, Sun, A, Wang, S-Y, Hu, C, Redman, M, van der Noort, V, Li, N, Guckenberger, M, van Tinteren, H, Hendriks, LEL, Groen, HJM, Joore, MA & De Ruysscher, DKM 2022, 'Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer', Radiotherapy and Oncology, vol. 170, pp. 95-101. https://doi.org/10.1016/j.radonc.2022.02.036

TY - JOUR

T1 - Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer

AU - Witlox, Willem J A

AU - Ramaekers, Bram L T

AU - Lacas, Benjamin

AU - Le Pechoux, Cecile

AU - Sun, Alexander

AU - Wang, Si-Yu

AU - Hu, Chen

AU - Redman, Mary

AU - van der Noort, Vincent

AU - Li, Ning

AU - Guckenberger, Matthias

AU - van Tinteren, Harm

AU - Hendriks, Lizza E L

AU - Groen, Harry J M

AU - Joore, Manuela A

AU - De Ruysscher, Dirk K M

PY - 2022/5

Y1 - 2022/5

N2 - INTRODUCTION: In stage III non-small cell lung cancer (NSCLC), prophylactic cranial irradiation (PCI) reduces the brain metastases incidence and prolongs the progression-free survival without improving overall survival. PCI increases the risk of toxicity and is currently not adopted in routine care. Our objective was to assess the cost-effectiveness of PCI compared with no PCI in stage III NSCLC from a Dutch societal perspective.METHODS: A cohort partitioned survival model was developed based on individual patient data from three randomized phase III trials (N=670). Quality-adjusted life years (QALYs) and costs were estimated over a lifetime time horizon.. A willingness-to-pay (WTP) threshold of €80,000 per QALY was adopted. Sensitivity and scenario analyses were performed to address parameter uncertainty and to explore what parameters had the greatest impact on the cost-effectiveness results.RESULTS: PCI was more effective and costly (0.443 QALYs, €10,123) than no PCI, resulting in an incremental cost-effectiveness ratio (ICER) of €22,843 per QALY gained. The probability of PCI being cost-effective at a WTP threshold of €80,000 per QALY was 93%. The probability of PCI gaining three and six additional months of life were 76% and 56%. The scenario analysis adding durvalumab increased the ICER to €35,159 per QALY gained. Using alternative survival distributions had little impact on the ICER. Assuming fewer PCI fractions and excluding indirect costs decreased the ICER to €18,263 and €5,554 per QALY gained.CONCLUSION: PCI is cost-effective compared to no PCI in stage III NSCLC, and could therefore, from a cost-effectiveness perspective, be considered in routine care.

AB - INTRODUCTION: In stage III non-small cell lung cancer (NSCLC), prophylactic cranial irradiation (PCI) reduces the brain metastases incidence and prolongs the progression-free survival without improving overall survival. PCI increases the risk of toxicity and is currently not adopted in routine care. Our objective was to assess the cost-effectiveness of PCI compared with no PCI in stage III NSCLC from a Dutch societal perspective.METHODS: A cohort partitioned survival model was developed based on individual patient data from three randomized phase III trials (N=670). Quality-adjusted life years (QALYs) and costs were estimated over a lifetime time horizon.. A willingness-to-pay (WTP) threshold of €80,000 per QALY was adopted. Sensitivity and scenario analyses were performed to address parameter uncertainty and to explore what parameters had the greatest impact on the cost-effectiveness results.RESULTS: PCI was more effective and costly (0.443 QALYs, €10,123) than no PCI, resulting in an incremental cost-effectiveness ratio (ICER) of €22,843 per QALY gained. The probability of PCI being cost-effective at a WTP threshold of €80,000 per QALY was 93%. The probability of PCI gaining three and six additional months of life were 76% and 56%. The scenario analysis adding durvalumab increased the ICER to €35,159 per QALY gained. Using alternative survival distributions had little impact on the ICER. Assuming fewer PCI fractions and excluding indirect costs decreased the ICER to €18,263 and €5,554 per QALY gained.CONCLUSION: PCI is cost-effective compared to no PCI in stage III NSCLC, and could therefore, from a cost-effectiveness perspective, be considered in routine care.

KW - CHEMORADIOTHERAPY

KW - Cohort partitioned survival model

KW - Cost-effectiveness analysis

KW - HIGH-RISK

KW - METASTASES

KW - Prophylactic cranial irradiation

KW - RADIATION

KW - Stage III non-small cell lung cancer

KW - TRIAL

KW - TUMORS

U2 - 10.1016/j.radonc.2022.02.036

DO - 10.1016/j.radonc.2022.02.036

M3 - Article

C2 - 35259416

SN - 0167-8140

VL - 170

SP - 95

EP - 101

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -