Intensity-modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3D-CRT) for head and neck cancer: cost-effectiveness analysis

SUMMARY BACKGROUND: A cost-effectiveness analysis of IMRT compared to 3D-CRT for head and neck cancer patients (HNCPs) was conducted in the Brazilian Public Health System. METHODS: A Markov model was used to simulate radiation therapy-induced dysphagia and xerostomia in HNCPs. Data from the PARSPORT trial and the quality-of-life study were used as parameters. The incremental cost-effectiveness ratio (ICER) and cost per quality-adjusted life-year (QALY) gained were calculated. RESULTS: At 2 years, IMRT was associated with an incremental benefit of 0.16 QALYs gained per person, resulting in an ICER of BRL 31,579 per QALY gained. IMRT was considered cost-effective when using the guideline proposed by the World Health Organization (WHO) of three times the national gross domestic product (GDP) per capita (BRL 72,195). Regarding life expectancy (15 years), the incremental benefit of IMRT was 1.16 QALYs gained per person, with an ICER of BRL 4,341. IMRT was also cost-effective using the WHO definition, which states that the maximum cost is equal to the GDP per capita (BRL 24,065). CONCLUSIONS: IMRT was considered cost-effective from the perspective of the Brazilian public health system.

RESUMO INTRODUÇÃO: Foi realizada uma análise de custo-efetividade da radioterapia com intensidade modulada de feixe (IMRT) comparada com a radioterapia conformada para pacientes com câncer de cabeça e pescoço (CCP) no contexto do Sistema Único de Saúde (SUS). MÉTODOS: Foi elaborado um modelo de Markov para comparar os custos médicos diretos e os desfechos de saúde relacionados à qualidade de vida do paciente pós-intervenção radioterápica sofrendo de xerostomia e disfagia. Com essa finalidade, foram usados os dados do estudo PARSPORT e parâmetros de qualidade de vida. Os resultados comparativos das estratégias alternativas de tratamento foram medidos pela razão de custo-efetividade incremental (RCEI). O desfecho analisado foi o de anos de vida ajustados à qualidade (QALY). RESULTADOS: Em um horizonte de tempo de dois anos, a IMRT foi associada com um benefício incremental de ganho de 0,16 QALYs por indivíduo, resultando em um RCEI de R$ 31.579 por QALY ganhado. A IMRT foi custo-efetivo, adotando-se o limite máximo de disposição a pagar, proposto pela OMS, de três vezes o PIB per capita nacional, equivalente a R$ 72.195. No horizonte de tempo de 15 anos, o benefício incremental de ganho foi de 1,16 QALYs por indivíduo, com um RCEI de R$ 4.341. A IMRT foi custo-efetivo, adotando-se o limite de disposição a pagar, proposto pela OMS, de uma vez o PIB per capita nacional, equivalente a R$ 24.065. CONCLUSÃO: A IMRT foi considerada um tratamento custo-efetivo na perspectiva do SUS.

Comparación de costes de tres tratamientos del cáncer de próstata localizadoen España: prostatectomía radical, braquiterapia prostáticay radioterapia conformacional externa 3D / Cost comparison of three treatments for localized prostate cancer in Spain: radical prostatectomy, prostate brachytherapy and external 3D conformal radiotherapy

Objetivo: Comparar los costes de los tratamientos más establecidos para el cáncer de próstata localizadosegún grupos de riesgo, edad y comorbilidad, desde la perspectiva del proveedor asistencial.Métodos: Comparación de costes en pacientes reclutados consecutivamente entre 2003 y 2005 enuna unidad funcional de tratamiento del cáncer de próstata. La utilización de servicios hasta 6 mesesdespués del inicio del tratamiento se obtuvo de las bases de datos hospitalarias, y los costes directosse estimaron mediante cálculo microcoste. La información sobre las características clínicas de lospacientes y los tratamientos recogió prospectivamente. Los costes se compararon mediante tests noparamétricos de comparación de medianas (Kruskall-Wallis) y un modelo semilogarítmico de regresiónmúltiple.Resultados: La diferencia de costes fue estadísticamente significativa: medianas de 3229.10 D , 5369.00D y 6265.60 D para los pacientes tratados con radioterapia conformacional externa 3D, braquiterapia,y prostatectomía radical retropública, respectivamente (p < 0,001). En el análisis multivariado (R2 ajustada= 0,8), los costes medios de la braquiterapia y de la radioterapia externa fueron significativamentemenores que los de la prostatectomía (coeficiente -0,212 y -0,729, respectivamente).Conclusiones: La prostatectomía radical resultó ser la opción terapéutica de mayor coste. En general, loscostes estimados en nuestro estudio son inferiores a los publicados en otros ámbitos. La opción terapéuticaexplica gran parte de los costes, y tanto la comorbilidad como el grupo de riesgo no mostraron efectoindependiente del tratamiento sobre los costes totales (AU)

Objective: To compare the initial costs of the three most established treatments for clinically localizedprostate cancer according to risk, age and comorbidity groups, from the healthcare provider’s perspective.Methods: We carried out a cost comparison study in a sample of patients consecutively recruitedbetween 2003 and 2005 from a functional unit for prostate cancer treatment in Catalonia (Spain).The use of services up to 6 months after the treatment start date was obtained from hospitaldatabases and direct costs were estimated by micro-cost calculation. Information on the clinical characteristicsof patients and treatments was collected prospectively. Costs were compared by usingnonparametric tests comparing medians (Kruskall-Wallis) and a semi-logarithmic multiple regressionmodel. Results: Among the 398 patients included, the cost difference among treatments was statistically significant:medians were D 3,229.10, D 5,369.00 and D 6,265.60, respectively, for the groups of patientstreated with external 3D conformal radiotherapy, brachytherapy and radical retropublic prostatectomy,(p < 0.001). In the multivariate analysis (adjusted R2 = 0.8), the average costs of brachytherapy and externalradiotherapy were significantly lower than that of prostatectomy (coefficient -0.212 and -0.729,respectively).Conclusions: Radical prostatectomy proved to be the most expensive treatment option. Overall, theestimated costs in our study were lower than those published elsewhere. Most of the costs were explainedby the therapeutic option and neither comorbidity nor risk groups showed an effect on total costsindependent of treatment (AU)