Division of Imaging & Oncology, University Medical Center Utrecht, The Netherlands; Julius Clinical, Zeist, The Netherlands.
Division of Imaging & Oncology, University Medical Center Utrecht, The Netherlands.
Radiother Oncol. 2021 Aug;161:74-82. doi: 10.1016/j.radonc.2021.05.022. Epub 2021 Jun 3.
1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Clinical evidence is lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy.
A state transition model was developed for men with localized prostate cancer. Complication rates such as grade ≥2 urinary, grade ≥2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR-Linac to be cost-effective, while holding other outcomes such as biochemical progression and mortality constant. One-way sensitivity analyses were performed to outline uncertainty outcomes.
At €6460 per patient, no reductions in complications were needed to consider MR-Linac cost-effective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression.
MR-Linac is found to be cost-effective compared to 20 and 39 fractions EBRT at baseline. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs.
1.5 特斯拉磁共振引导放射治疗直线加速器（MR-Linac）因其治疗局限性前列腺癌的潜力而受到关注。但目前缺乏临床证据，因此尚不清楚 MR-Linac 是否具有成本效益。本研究旨在进行早期卫生经济学分析，以计算与 5、20 和 39 分次外照射放疗（EBRT）和低剂量率（LDR）近距离放疗相比，MR-Linac 治疗局限性前列腺癌所需的并发症相对减少的幅度和最大价格，以确保其具有成本效益。
本研究为局限性前列腺癌患者建立了状态转移模型。基于系统文献检索，确定了≥2 级尿、≥2 级肠和性功能障碍等并发症发生率和效用值。从荷兰医疗保健的角度估算了成本。通过阈值分析，确定了使 MR-Linac 具有成本效益的并发症和成本阈值，同时保持生化进展和死亡率等其他结果不变。还进行了单因素敏感性分析，以评估不确定性结果。
如果每位患者的费用为 6460 欧元，则无需减少并发症即可认为 MR-Linac 与 20 和 39 分次 EBRT 相比具有成本效益。与 5 分次 EBRT 和 LDR 近距离放疗相比，当并发症相对减少 54%和 66%时，MR-Linac 具有成本效益。研究结果高度敏感于尿、肠和性功能障碍的效用值以及生化进展的概率。
与 20 和 39 分次 EBRT 相比，MR-Linac 在基线时具有成本效益。为了使 MR-Linac 在 5 分次 EBRT 和 LDR 近距离放疗方面具有成本效益，必须大幅降低并发症发生率或降低成本。
