University of Texas Southwestern, Dallas, TX; and Northern Michigan Health, Petoskey, MI.
J Oncol Pract. 2012 May;8(3 Suppl):e31s-7s. doi: 10.1200/JOP.2012.000548.
The purpose of this study is to compare the cost-effectiveness of two external beam radiation therapy techniques for treatment of low- to intermediate-risk prostate cancer: stereotactic body radiation therapy (SBRT) and intensity-modulated radiation therapy (IMRT).
A Markov decision analysis model with probabilistic sensitivity analysis was designed with the various disease states of a 70-year-old patient with organ-confined prostate cancer to evaluate the cost-effectiveness of two external beam radiation treatment options.
The Monte Carlo simulation revealed that the mean cost and quality-adjusted life-years (QALYs) for SBRT and IMRT were $22,152 and 7.9 years and $35,431 and 7.9 years, respectively. The sensitivity analysis revealed that if the SBRT cohort experienced a decrease in quality of life of 4% or a decrease in efficacy of 6%, then SBRT would no longer dominate IMRT in cost-effectiveness. In fact, with these relaxed assumptions for SBRT, the incremental cost-effectiveness ratio of IMRT met the societal willingness to pay threshold of $50,000 per QALY.
Compared with IMRT, SBRT for low- to intermediate-risk prostate cancer has great potential cost savings for our health care system payers and may improve access to radiation, increase patient convenience, and boost quality of life for patients. Our model suggests that the incremental cost-effectiveness ratio of IMRT compared with SBRT is highly sensitive to quality-of-life outcomes, which should be adequately and comparably measured in current and future prostate SBRT studies.
本研究旨在比较两种用于治疗低危至中危前列腺癌的外部束放射治疗技术的成本效益：立体定向体部放射治疗（SBRT）和强度调制放射治疗（IMRT）。
采用Markov 决策分析模型和概率敏感性分析，对一位 70 岁局限于器官的前列腺癌患者的各种疾病状态进行设计，以评估两种外部束放射治疗选择的成本效益。
蒙特卡罗模拟结果显示，SBRT 和 IMRT 的平均成本和质量调整生命年（QALYs）分别为 22152 美元和 7.9 年，35431 美元和 7.9 年。敏感性分析表明，如果 SBRT 组的生活质量下降 4%或疗效下降 6%，则 SBRT 在成本效益方面不再优于 IMRT。事实上，在对 SBRT 放宽这些假设的情况下，IMRT 的增量成本效益比符合社会对每 QALY 支付 50000 美元的意愿支付阈值。
与 IMRT 相比，SBRT 治疗低危至中危前列腺癌可能为我们的医疗保健系统支付者带来巨大的成本节约，并可能改善放疗的可及性，提高患者的便利性，并提高患者的生活质量。我们的模型表明，与 SBRT 相比，IMRT 的增量成本效益比高度敏感于生活质量结果，在当前和未来的前列腺 SBRT 研究中，这些结果应得到充分和可比的衡量。
