Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - Ribeirão Preto (SP), Brazil.
Instituto de Biociência da Universidade do Estado de São Paulo - Botucatu (SP), Brazil.
Rev Assoc Med Bras (1992). 2021 Jun;67(5):724-730. doi: 10.1590/1806-9282.20210078.
The intensity-modulated radiotherapy (IMRT) has been established as the standard external-beam radiation technique to treat prostate cancer in several countries. In Brazil, the public health system and the National Health Agency do not reimburse its utilization. This study compared the cost-effectiveness of IMRT and tridimensional radiotherapy (3D-RT) from a payer's perspective.
We built a Markov model to delineate the health states after treatment with IMRT and 3D-RT. The treatment-related toxicity data were extracted from the literature. The sensitivity analyses were performed over potential parameters.
The incremental cost of IMRT was R$ 5,553.78. At a time horizon of 5 years, the quality-adjusted life expectancy after IMRT was higher than 3D-RT. The incremental cost-effectiveness ratio (ICER) of IMRT over 3D-RT was R$-296,74/quality-adjusted life year (QALY). Therefore, IMRT was the dominant strategy, which depended on the value of interventional procedures for severe toxicity and the difference between IMRT and 3D-RT reimbursement. The IMRT was still most likely to be cost-effective at a willingness-to-pay R$ 100,000/QALY, with a net monetary benefit (NMB) superior to 3D-RT after R$ 50,000.00, resulting in a difference of R$220.000,00 after 5 years.
IMRT generated more values than 3D-RT for external-beam treatment. Given its potential to reduce late toxicity with hypofractionation, these data reinforce its incorporation to treat prostate cancer in the Brazilian health system from a payer's perspective.
调强放疗（IMRT）已被确立为治疗前列腺癌的标准外照射放疗技术，在多个国家得到应用。在巴西，公共卫生系统和国家卫生署不报销其使用费用。本研究从支付方的角度比较了 IMRT 和三维适形放疗（3D-RT）的成本效益。
我们构建了一个马尔可夫模型来描述接受 IMRT 和 3D-RT 治疗后的健康状态。治疗相关毒性数据从文献中提取。进行了潜在参数的敏感性分析。
IMRT 的增量成本为 5553.78 雷亚尔。在 5 年的时间内，IMRT 治疗后的质量调整生命预期高于 3D-RT。IMRT 相对于 3D-RT 的增量成本效益比（ICER）为每质量调整生命年（QALY）-29674 雷亚尔。因此，IMRT 是一种主导策略，取决于严重毒性介入治疗的价值以及 IMRT 和 3D-RT 报销之间的差异。在愿意支付每 QALY100000 雷亚尔的情况下，IMRT 仍然极有可能具有成本效益，并且在 50000 雷亚尔之后，其净货币收益（NMB）优于 3D-RT，5 年后差异为 220000 雷亚尔。
与 3D-RT 相比，IMRT 为外照射治疗提供了更多的价值。考虑到其通过分割照射降低晚期毒性的潜力，从支付方的角度来看，这些数据支持将其纳入巴西卫生系统治疗前列腺癌。
