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 journalArticleAcademicpeer-review


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 languageEnglish
Pages (from-to)95-101
Number of pages7
JournalRadiotherapy and Oncology
Early online date5 Mar 2022
Publication statusPublished - May 2022


  • Cohort partitioned survival model
  • Cost-effectiveness analysis
  • Prophylactic cranial irradiation
  • Stage III non-small cell lung cancer

Cite this