Qu Xuanlu M, Mishra Mark V, Bauman Glenn S, Slotman Ben, Mehta Minesh, Gondi Vinai, Louie Alexander V
Queen's University, Kingston, ON, Canada.
University of Maryland, Baltimore, MD, USA.
Radiother Oncol. 2017 Mar;122(3):411-415. doi: 10.1016/j.radonc.2017.01.005. Epub 2017 Jan 18.
Prophylactic cranial irradiation (PCI) in limited stage small cell lung cancer (LS-SCLC) prevents brain metastases and improves survival, with the potential for neurocognitive toxicity. RTOG0933 demonstrated that hippocampal avoidance (HA) during whole brain radiotherapy preserves neurocognition. This study's objective was to evaluate the cost-effectiveness of HA-PCI in LS-SCLC through decision analysis.
A Markov model was developed to simulate the clinical course of LS-SCLC who received HA-PCI or conventional PCI (C-PCI). A willingness-to-pay threshold of $100,000/QALY was used. Incremental cost effectiveness ratio was calculated (ICER). Sensitivity analyses were performed to determine the parameter thresholds and to assess the robustness of the model.
In the base case scenario, HA-PCI is more cost-effective than C-PCI, with an ICER of $47,107/QALY. HA-PCI was preferred over C-PCI provided that the risk of developing brain metastases was not increased by at least 14%, or if neurocognitive dysfunction rates were reduced by at least 40%. HA-PCI was the cost-effective strategy in 68% of tested iterations in probabilistic sensitivity analysis.
This study demonstrates that HA-PCI is more cost-effective than C-PCI in LS-SCLC. Our results support the use of HA-PCI in this patient population, should results from RTOG0933 be confirmed by the ongoing NRGCC003 trial.
局限期小细胞肺癌（LS-SCLC）的预防性颅脑照射（PCI）可预防脑转移并提高生存率，但存在神经认知毒性的风险。RTOG0933研究表明，全脑放疗期间避开海马体（HA）可保留神经认知功能。本研究的目的是通过决策分析评估HA-PCI在LS-SCLC中的成本效益。
建立马尔可夫模型，以模拟接受HA-PCI或传统PCI（C-PCI）的LS-SCLC的临床病程。采用的支付意愿阈值为100,000美元/质量调整生命年（QALY）。计算增量成本效益比（ICER）。进行敏感性分析以确定参数阈值并评估模型的稳健性。
在基础病例情景中，HA-PCI比C-PCI更具成本效益，ICER为47,107美元/QALY。如果发生脑转移的风险增加不超过14%，或者神经认知功能障碍率降低至少40%，则HA-PCI优于C-PCI。在概率敏感性分析中，HA-PCI在68%的测试迭代中是具有成本效益的策略。
本研究表明，HA-PCI在LS-SCLC中比C-PCI更具成本效益。如果正在进行的NRGCC003试验证实RTOG0933的结果，我们的结果支持在该患者群体中使用HA-PCI。
