Kim Hayeon, Rajagopalan Malolan S, Beriwal Sushil, Huq M Saiful, Smith Kenneth J
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA.
Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA.
Brachytherapy. 2015 Jan-Feb;14(1):29-36. doi: 10.1016/j.brachy.2014.09.002. Epub 2014 Oct 16.
Three-dimensional image-guided brachytherapy (IGBT) is a significant advance in locally advanced cervical cancer treatment. However, its cost-effectiveness (C/E) is unknown. We performed a C/E analysis of IGBT compared with conventional (two-dimensional [2D]) brachytherapy in the treatment of locally advanced cervical cancer.
A Markov model was constructed to model locally advanced cervical cancer treated with five fractions of high-dose-rate brachytherapy. The model captured clinical parameters, quality of life utility, and treatment costs through the literature review. Costs were 2013 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life-years (QALYs). To account for uncertainty, one-way, two-way, and probabilistic sensitivity analyses were performed. Strategies were evaluated from a payer's perspective with a willingness-to-pay threshold of $50,000/QALY gained.
Treatment costs for five fractions of IGBT and 2D brachytherapy were $21,374 and $17,931, respectively. In the base-case analysis, the IGBT strategy costs $3003 more than 2D brachytherapy while gaining 0.16 QALYs, resulting in an ICER of $18,634 per QALY gained. In one-way sensitivity analyses, results were most sensitive to variation of treatment costs, but the ICER remained <$50,000/QALY gained for all cost ranges. Variation of survival, local control, and complication rates was less influential. A probabilistic sensitivity analysis demonstrated that IGBT was favored in 63% of model iterations at a $50,000/QALY gained threshold.
IGBT for locally advanced cervical cancer is a C/E option compared with 2D brachytherapy. These findings were robust to variation of parameter values supporting the routine use of IGBT in locally advanced cervical cancer.
三维图像引导近距离放射治疗（IGBT）是局部晚期宫颈癌治疗的一项重大进展。然而，其成本效益（C/E）尚不清楚。我们对IGBT与传统（二维[2D]）近距离放射治疗在局部晚期宫颈癌治疗中的成本效益进行了分析。
构建了一个马尔可夫模型，用于模拟接受五分次高剂量率近距离放射治疗的局部晚期宫颈癌。该模型通过文献综述获取临床参数、生活质量效用和治疗成本。成本为2013年医疗保险报销费用。使用增量成本效益比（ICER）比较策略，并以质量调整生命年（QALY）衡量有效性。为考虑不确定性，进行了单向、双向和概率敏感性分析。从支付者的角度评估策略，获得每QALY的支付意愿阈值为50,000美元。
五分次IGBT和2D近距离放射治疗的治疗成本分别为21,374美元和17,931美元。在基础病例分析中，IGBT策略比2D近距离放射治疗多花费3003美元，同时获得0.16个QALY，导致每获得一个QALY的ICER为18,634美元。在单向敏感性分析中，结果对治疗成本的变化最为敏感，但在所有成本范围内，ICER仍低于每获得一个QALY 50,000美元。生存率、局部控制率和并发症发生率的变化影响较小。概率敏感性分析表明，在每获得一个QALY 50,000美元的阈值下，63%的模型迭代中IGBT更受青睐。
与2D近距离放射治疗相比，IGBT用于局部晚期宫颈癌是一种成本效益选择。这些发现对参数值的变化具有稳健性，支持在局部晚期宫颈癌中常规使用IGBT。
