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- Title
Cost-Utility Analysis of Short-Versus Long-Course Palliative Radiotherapy in Patients With Non-Small-Cell Lung Cancer.
- Authors
van den Hout, Wilbert B.; Kramer, Gijsbert W. P. M.; Noordijk, Ed M.; Leer, Jan-Willem H.
- Abstract
Background: Radiotherapy can effectively palliate the symptoms of poor-prognosis patients with non-small-cell lung cancer. However, controversy remains about whether short-course or more protracted radiotherapy schedules provide better value for the money. We conducted a societal cost-utility analysis of a Dutch multicenter randomized trial with 1-year follow-up that compared the efficacy of radiotherapy schedules consisting of 10 fractions of 3 Gy (10 × 3 Gy) versus two fractions of 8 Gy (2 × 8 Gy) in 297 patients with inoperable stage IIIA/B or stage IV non-small-cell lung cancer. This trial found that the 10 × 3-Gy group had better survival than the 2 × 8-Gy group. Methods: Lifetime quality-adjusted life-years (QALY5) were estimated using the EuroQol questionnaire. Lifetime societal costs were estimated using a model estimated based on data from cost questionnaires filled out by a subset of patients (n = 56). Differences were analyzed statistically using two-sided nonparametric bootstrapping. Results: Compared with the 2 × 8-Gy group, the 10 × 3-Gy group accrued statistically significantly more QALYs (20.0 versus 13.2 weeks; difference = 6.8 weeks, 95% confidence interval [CI] = 0.1 to 13.5 weeks, P = .05), which was mainly due to the statistically significantly better survival (38.1 versus 27.4 weeks; difference = 10.7 weeks, 95% CI = 0.9 to 20.6 weeks, P = .03) without a statistically significant difference with respect to the average valuation of health (P = .27). Total radiotherapy and radiotherapy-related costs were estimated at $5236 for the 10 × 3-Gy group and $2512 for the 2 × 8-Gy group (difference = $2724, 95% CI $2501 to $2947, P<.001). The 39% increase in life expectancy in the 10 × 3-Gy group as compared with the 2 × 8-Gy group was associated with a 30% increase in survival-related nonradiotherapy costs ($11 254 versus $8651, difference $2602, 95% CI = -$357 to $5562, P = .09). The cost-utility ratio for the 10 × 3-Gy schedule versus the 2 × 8-Gy schedule was estimated at $40900 per QALY (95% CI = $19400 to $1 100000 per QALY). Conclusions: In these poor-prognosis non-small-cell lung cancer patients, the estimated cost-utility ratio for the palliative 10 × 3-Gy schedule was acceptable according to current economic standards. However, the additional costs for the protracted schedule were justified not by improved quality of life but by longer survival.
- Subjects
CANCER; THERAPEUTICS; RADIOTHERAPY; HOSPITAL radiological services; LUNG cancer; COST; PALLIATIVE treatment; MEDICAL research
- Publication
JNCI: Journal of the National Cancer Institute, 2006, Vol 98, Issue 24, p1786
- ISSN
0027-8874
- Publication type
Article
- DOI
10.1093/jnci/djj496