Is Radiation Therapy Cost-Effective in the Positron Emission Tomography/Computed Tomography Era for Early-Stage Favorable Hodgkin Lymphoma With Alternative Payment Models?

• Published in: Practical radiation oncology Vol. 12; no. 2; p. e135
• Main Authors: Kim, Hayeon, Richman, Adam, Smith, Kenneth J, Shaikh, Parvez M, Beriwal, Sushil, Vargo, John A
• Format: Journal Article
• Language: English
• Published: United States 01.03.2022
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bleomycin - therapeutic use; Cost-Benefit Analysis; Dacarbazine - therapeutic use; Doxorubicin - therapeutic use; Hodgkin Disease - drug therapy; Hodgkin Disease - pathology; Hodgkin Disease - radiotherapy; Humans; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Vinblastine - therapeutic use
• ISSN: 1879-8519
• DOI: 10.1016/j.prro.2021.11.010

Despite multiple randomized trials, variation in practice remains regarding the most effective treatment for early-stage, favorable-risk Hodgkin lymphoma. With increasing emphasis on alternative payment models, we investigate the cost-effectiveness of chemotherapy alone versus combined modality therapy (CMT). A Markov model was formed to compared 2 cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) to 2 cycles of ABVD followed by 20 Gy in 10 fractions involved-site radiation therapy. Modalities were compared using the incremental cost-effectiveness ratio, with effectiveness measured in quality-adjusted life years (QALYs) and evaluated with a willingness to pay a threshold of $100,000 per QALY gained. The base case analysis showed that CMT is cost-effective compared with ABVD alone, with an incremental cost-effectiveness ratio of $8028 per QALY gained and an incremental cost of $236 gaining 0.029 QALYs. On sensitivity analyses, the results were the most sensitive to changes in recurrence rates. If the recurrence rate differences were ≥6%, CMT was cost-effective. CMT is a cost-effective strategy for early-stage, favorable-risk Hodgkin lymphoma based on currently available evidence. However, small variations in recurrence-rate estimates dramatically affect strategy cost-effectiveness.