Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
Int J Radiat Oncol Biol Phys. 2021 Apr 1;109(5):1185-1194. doi: 10.1016/j.ijrobp.2020.09.045. Epub 2020 Sep 28.
The Stereotactic Ablative Radiation therapy for Comprehensive Treatment of Oligometastatic Tumors phase 2 randomized clinical trial found that stereotactic ablative radiation therapy (SABR) improved outcomes among cancer patients with oligometastatic disease. Yet, the cost of SABR along with the large number of patients with oligometastatic disease raises the important question of value. This study sought to evaluate the cost-effectiveness of the addition of SABR compared with standard therapy alone among cancer patients with oligometastatic disease.
We constructed a Markov model to simulate treatment with stereotactic ablative radiation therapy or standard therapy among patients with oligometastatic cancers. The model derived transition probabilities from Stereotactic Ablative Radiation therapy for Comprehensive Treatment of Oligometastatic Tumors clinical trial data to estimate risks of toxicity, disease progression and survival. Health care costs and health utilities were estimated from the literature. Probabilistic and one-way sensitivity analyses evaluate model uncertainty. Cost-effectiveness was estimated from both the health care sector and societal perspectives with an incremental cost-effectiveness ratio (ICER) defined as dollars per quality-adjusted life year (QALY). An ICER less than $100,000/QALY was considered cost-effective. One-way and probabilistic sensitivity analyses were used to examine model uncertainty.
The addition of SABR increased total costs by $54,260 (health care sector perspective) or $72,799 (societal perspective) and improved effectiveness by 1.88 QALYs compared with standard therapy, leading to an ICER of $28,906/QALY (health care sector perspective) or $38,783/QALY (societal perspective). The model was modestly sensitive to assumptions about tumor progression, although the model was not sensitive to assumptions about survival or cost of treatment. Probabilistic sensitivity analyses demonstrated that SABR was the cost-effective treatment option 99.8% (health care sector perspective) or 98.7% (societal perspective) of the time.
The addition of SABR increased costs and improved quality adjusted survival, overall leading to a cost-effective treatment strategy for patients with oligometastatic cancer.
立体定向消融放疗综合治疗寡转移瘤的 2 期随机临床试验发现，立体定向消融放疗（SABR）改善了寡转移疾病患者的预后。然而，SABR 的成本加上大量患有寡转移疾病的患者，提出了一个重要的价值问题。本研究旨在评估在寡转移疾病患者中，与单独标准治疗相比，添加 SABR 的成本效益。
我们构建了一个马尔可夫模型，以模拟寡转移癌症患者接受立体定向消融放疗或标准治疗。该模型从立体定向消融放疗综合治疗寡转移瘤临床试验数据中得出转移概率，以估计毒性、疾病进展和生存风险。医疗保健成本和健康效用从文献中估算。概率和单向敏感性分析评估模型不确定性。从医疗保健部门和社会角度评估成本效益，增量成本效益比（ICER）定义为每质量调整生命年（QALY）的美元数。ICER 低于 100,000 美元/QALY 被认为是具有成本效益的。单向和概率敏感性分析用于检查模型不确定性。
与标准治疗相比，添加 SABR 使总费用增加了 54,260 美元（医疗保健部门视角）或 72,799 美元（社会视角），并提高了 1.88 个 QALY，导致 ICER 为 28,906 美元/QALY（医疗保健部门视角）或 38,783 美元/QALY（社会视角）。该模型对肿瘤进展的假设略敏感，但对生存或治疗成本的假设不敏感。概率敏感性分析表明，在 99.8%（医疗保健部门视角）或 98.7%（社会视角）的时间内，SABR 是具有成本效益的治疗选择。
添加 SABR 增加了成本并提高了质量调整后的生存，总体上为寡转移癌患者提供了一种具有成本效益的治疗策略。
