Juravinski Cancer Center, Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada.
Department of Health Economics, McMaster University, Hamilton, Ontario, Canada.
Clin Genitourin Cancer. 2022 Oct;20(5):e353-e361. doi: 10.1016/j.clgc.2022.03.011. Epub 2022 Mar 28.
To conduct a cost-effectiveness analysis of stereotactic body radiotherapy (SBRT) versus radiofrequency ablation (RFA) in the non-surgical management of early stage renal cell carcinoma (RCC) according to Consolidated Health Economic Evaluation Reporting Standards (CHEERS) criteria in the Canadian healthcare system.
A Markov state transition model was constructed for initial local treatment with RFA or SBRT for early stage, kidney confined, medically inoperable RCC in a hypothetical cohort. Incremental cost effectiveness ratios (ICER) were then calculated to compare the two treatments. The analysis was conducted over 5-year time horizon from the perspective of a publicly funded health system in Canada. Secondary analyses were conducted to assess the effect of small versus large size (< 4 cm vs. > 4 cm) RCC on ICERs. Multiple one-way deterministic sensitivity analysis were conducted. Discounting of 1.5% per year was applied.
Over 5 years, SBRT economically dominated RFA with a gain of 4.103 quality-adjusted life years (QALYs) and a cost of $16,097, compared with 3.607 QALYs at a cost of $18,324 for RFA. The ICER was $4490 CAD less per QALY for SBRT in the base case analysis (BCE). In patients with small tumors (T1a), SBRT compared with RFA was more effective and marginally more costly, resulting in an ICER of $2207 CAD per QALY gained, while for larger tumors (T1b), SBRT was less costly and more effective than RFA, resulting in an ICER of -$22904. Sensitivity analysis demonstrated significant variability in the cost-effectiveness of SBRT versus RFA when parameters were varied, with rates of distant metastasis following RFA or SBRT having the greatest implications on ICERs.
Overall, SBRT used as a primary treatment for RCC shows promising effectiveness at an overall reduction in cost compared with RFA in the Canadian healthcare system. The use of SBRT appears to be cost-effective for larger tumors as well as smaller tumors. The validity of these conclusions are highly sensitive to the accuracy of local and distant progression rates reported in previous studies, and may be adjusted as the available data on SBRT and RFA continues to evolve and mature.
根据加拿大医疗保健系统的统一健康经济评估报告标准（CHEERS）标准，对立体定向体放射治疗（SBRT）与射频消融（RFA）在早期肾细胞癌（RCC）非手术治疗中的成本效益进行分析。
为了在假设队列中对早期、局限性、不能手术的肾细胞癌进行初始局部治疗，构建了一个用于 RFA 或 SBRT 的 Markov 状态转移模型。然后，计算了增量成本效益比（ICER），以比较两种治疗方法。该分析在加拿大公共资助的医疗保健系统的 5 年时间范围内进行。进行了二次分析以评估大小（<4cm 与>4cm）RCC 对 ICER 的影响。进行了多次确定性单因素敏感性分析。每年贴现 1.5%。
在 5 年内，SBRT 在经济上优于 RFA，其获得了 4.103 个质量调整生命年（QALY），成本为 16097 加元，而 RFA 的成本为 18324 加元，获得了 3.607 个 QALY。在基础案例分析（BCE）中，SBRT 的每个 QALY 节省了 4490 加元。在肿瘤较小（T1a）的患者中，SBRT 与 RFA 相比，更有效且略贵，导致每个获得的 QALY 的 ICER 为 2207 加元，而对于肿瘤较大（T1b）的患者，SBRT 的成本低于 RFA，并且更有效，导致每个获得的 QALY 的 ICER 为-22904 加元。敏感性分析表明，当参数变化时，SBRT 与 RFA 的成本效益存在很大的可变性，RFA 或 SBRT 后远处转移的发生率对 ICER 影响最大。
总的来说，SBRT 作为 RCC 的主要治疗方法，与加拿大医疗保健系统中的 RFA 相比，具有降低成本的前景。在加拿大医疗保健系统中，SBRT 似乎对较大肿瘤和较小肿瘤都具有成本效益。这些结论的有效性高度依赖于之前研究中报告的局部和远处进展率的准确性，并且随着 SBRT 和 RFA 的可用数据不断发展和成熟，可能会进行调整。
