Cross Cancer Institute and University of Alberta, Edmonton, Canada.
AC Camargo Cancer Center, São Paulo, Brazil.
Radiother Oncol. 2018 Apr;127(1):114-120. doi: 10.1016/j.radonc.2018.01.017. Epub 2018 Feb 13.
Short-course radiotherapy (25 Gy in five fractions) was recently shown in a randomized phase III trial to be non-inferior to 40 Gy in 15 fractions in elderly and/or frail patients with glioblastoma multiforme. This study compared the cost-effectiveness of the two regimens.
The direct unit costs of imaging, radiotherapy (RT), and dexamethasone were collected from the five primary contributing countries to the trial, constituting the data of 88% of all patients. Effectiveness was measured by the restricted mean overall survival (RMOS) and progression free survival (RMPFS). The incremental cost-effectiveness ratio (ICER) was calculated. Indirect costs were also estimated for comparison.
The median OSs for the short-course and commonly used RTs were 8.2 (95% confidence interval [CI] 6.1-10.3) and 7.7 (95% CI 5.5-9.9) months, respectively (log rank p = 0.340). Median PFSs were also not different (p = 0.686). The differences in the RMOS and the ICER, however, were +0.11 life-years and -$3062 United States dollars (USD) per life-year gained, respectively. The differences in the RMPFS and the ICER were +0.02 PFS and -$17,693 USD, respectively.
The ICER of -$3062 per life-year gained and -$17,693 per PFS gained indicates that the short-course RT is less costly compared to the longer RT regimen.
近期一项随机 III 期临床试验表明，对于多形性胶质母细胞瘤的老年和/或体弱患者，25Gy 分 5 次的短程放疗与 40Gy 分 15 次的放疗相比疗效非劣效。本研究比较了这两种方案的成本效益。
从试验的五个主要参与国家收集了成像、放疗（RT）和地塞米松的直接单位成本，构成了 88%的所有患者的数据。通过限制平均总生存期（RMOS）和无进展生存期（RMPFS）来衡量有效性。计算了增量成本效益比（ICER）。还估计了间接成本以作比较。
短程放疗和常用 RT 的中位 OS 分别为 8.2（95%置信区间[CI] 6.1-10.3）和 7.7（95% CI 5.5-9.9）个月（对数秩检验 p=0.340）。中位 PFS 也无差异（p=0.686）。然而，RMOS 和 ICER 的差异分别为+0.11 生命年和-3062 美元（USD）/每获得的生命年。RMPFS 和 ICER 的差异分别为+0.02 PFS 和-17693 美元。
ICER 为-3062 美元/每获得的生命年和-17693 美元/每获得的 PFS 表明，与较长的 RT 方案相比，短程 RT 的成本更低。
