Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling

Charisma Hehakaya*, Jochem R. N. van der Voort van Zyp, Ben G. L. Vanneste, Janneke P. C. Grutters, Diederick E. Grobbee, Helena M. Verkooijen, Geert W. J. Frederix

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)74-82
Number of pages9
JournalRadiotherapy and Oncology
Publication statusPublished - Aug 2021


  • MRI-guided radiotherapy
  • MR-Linac
  • Localized prostate cancer
  • Early cost-effectiveness
  • COST


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