London Health Sciences Centre, London, Canada; Schulich School of Medicine & Dentistry, Western University, London, Canada.
Schulich School of Medicine & Dentistry, Western University, London, Canada.
Int J Radiat Oncol Biol Phys. 2021 Apr 1;109(5):1176-1184. doi: 10.1016/j.ijrobp.2020.12.001. Epub 2020 Dec 10.
The phase 2 randomized study SABR-COMET demonstrated that in patients with controlled primary tumors and 1 to 5 oligometastatic lesions, SABR was associated with improved progression-free survival (PFS) compared with standard of care (SoC), but with higher costs and treatment-related toxicities. The aim of this study was to assess the cost-effectiveness of SABR versus SoC in this setting.
A Markov model was constructed to perform a cost-utility analysis from the Canadian health care system perspective. Utility values and transition probabilities were derived from individual-level data from the SABR-COMET trial. One-way, 2-way, and probabilistic sensitivity analyses were performed. Costs were expressed in 2018 CAD. A separate analysis based on US payer's perspective was performed. An incremental cost-effectiveness ratio (ICER) at a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was used.
In the base case scenario, SABR was cost-effective at an ICER of $37,157 per QALY gained. This finding was most sensitive to the number of metastatic lesions treated with SABR (ICER: $28,066 per QALY for 2, increasing to $64,429 per QALY for 5), difference in chemotherapy use (ICER: $27,173-$53,738 per QALY), and PFS hazard ratio (HR) between strategies (ICER: $31,548-$53,273 per QALY). Probabilistic sensitivity analysis revealed that SABR was cost-effective in 97% of all iterations. Two-way sensitivity analysis demonstrated a nonlinear relationship between the number of lesions and the PFS HR. To maintain cost-effectiveness for each additional metastasis, the HR must decrease by approximately 0.047. The US cost analysis yielded similar results, with an ICER of $54,564 (2018 USD per QALY) for SABR.
SABR is cost-effective for patients with 1 to 5 oligometastatic lesions compared with SoC.
SABR-COMET 是一项 2 期随机研究，结果表明，在原发性肿瘤得到控制且存在 1-5 个寡转移病灶的患者中，与标准治疗相比，SABR 可改善无进展生存期（PFS），但费用更高，且治疗相关毒性更大。本研究旨在评估 SABR 与该人群标准治疗相比的成本效果。
采用Markov 模型，从加拿大卫生保健系统的角度进行成本效用分析。效用值和转移概率源自 SABR-COMET 试验的个体水平数据。进行了单因素、双因素和概率敏感性分析。成本以 2018 年加元表示。还进行了基于美国支付方视角的单独分析。采用增量成本效果比（ICER）作为意愿支付阈值，即每获得 1 个质量调整生命年（QALY）的成本为 10 万加元。
在基础方案中，SABR 的 ICER 为每获得 1 个 QALY 需花费 37157 加元，具有成本效果。这一结果主要取决于 SABR 治疗的转移病灶数量（ICER：治疗 2 个病灶为 28066 加元/ QALY，增加至 5 个病灶则为 64429 加元/ QALY）、化疗应用差异（ICER：27173 至 53738 加元/ QALY）以及两种治疗策略的 PFS 风险比（HR）（ICER：31548 至 53273 加元/ QALY）。概率敏感性分析表明，SABR 在所有迭代中的 97%都具有成本效果。双因素敏感性分析表明，病灶数量与 PFS HR 之间存在非线性关系。为了使每个额外转移灶的治疗保持成本效果，HR 必须降低约 0.047。美国的成本分析得出了类似的结果，SABR 的 ICER 为 54564 美元（2018 年美元/ QALY）。
与标准治疗相比，SABR 对 1-5 个寡转移病灶的患者具有成本效果。
