TY - JOUR
T1 - Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer
T2 - Decision analytic modelling
AU - Hehakaya, Charisma
AU - Zyp, Jochem R. N. van der Voort van
AU - Vanneste, Ben G. L.
AU - Grutters, Janneke P. C.
AU - Grobbee, Diederick E.
AU - Verkooijen, Helena M.
AU - Frederix, Geert W. J.
N1 - Funding Information:
This project is part of the project ‘Clinical introduction online and real-time MRI-guided prostate cancer radiotherapy’ (project number 104006004) funded by the Netherlands Organization for Health Research and Development (ZonMw) via Innovative Medical Devices Initiative for Technology for Sustainable Healthcare. The funding body has had no part in the study design, data collection and analysis, and writing of this manuscript.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/8
Y1 - 2021/8
N2 - Background and purpose: 1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Clinical evidence is lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy.Materials and methods: A state transition model was developed for men with localized prostate cancer. Complication rates such as grade >= 2 urinary, grade >= 2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR-Linac to be cost-effective, while holding other outcomes such as biochemical progression and mortality constant. One-way sensitivity analyses were performed to outline uncertainty outcomes.Results: At is an element of 6460 per patient, no reductions in complications were needed to consider MR-Linac cost-effective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression.Conclusions: MR-Linac is found to be cost-effective compared to 20 and 39 fractions EBRT at baseline. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs. (C) 2021 The Author(s). Published by Elsevier B.V.
AB - Background and purpose: 1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Clinical evidence is lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy.Materials and methods: A state transition model was developed for men with localized prostate cancer. Complication rates such as grade >= 2 urinary, grade >= 2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR-Linac to be cost-effective, while holding other outcomes such as biochemical progression and mortality constant. One-way sensitivity analyses were performed to outline uncertainty outcomes.Results: At is an element of 6460 per patient, no reductions in complications were needed to consider MR-Linac cost-effective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression.Conclusions: MR-Linac is found to be cost-effective compared to 20 and 39 fractions EBRT at baseline. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs. (C) 2021 The Author(s). Published by Elsevier B.V.
KW - MRI-guided radiotherapy
KW - MR-Linac
KW - Localized prostate cancer
KW - Early cost-effectiveness
KW - FRACTIONATED RADIATION-THERAPY
KW - TOXICITY
KW - OUTCOMES
KW - COST
KW - BRACHYTHERAPY
KW - TECHNOLOGIES
U2 - 10.1016/j.radonc.2021.05.022
DO - 10.1016/j.radonc.2021.05.022
M3 - Article
C2 - 34089754
SN - 0167-8140
VL - 161
SP - 74
EP - 82
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -