Cost‐effectiveness of stereotactic body radiation therapy versus surgical resection for stage I non–small cell lung cancer

• Published in: Cancer Vol. 119; no. 17; pp. 3123 - 3132
• Main Authors: Shah, Anand, Hahn, Stephen M., Stetson, Robert L., Friedberg, Joseph S., Pechet, Taine T. V., Sher, David J.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley-Blackwell 01.09.2013
• Subjects: Adult; Aged; Aging; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - economics; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Cost-Benefit Analysis; cost‐effectiveness; Female; Health Care Costs; Humans; lobectomy; lung cancer; Lung Neoplasms - economics; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Markov Chains; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; Pneumology; Pneumonectomy - economics; Quality-Adjusted Life Years; Radiosurgery - economics; Research Design; Sensitivity and Specificity; stereotactic body radiation therapy; surgery; Tumors; Tumors of the respiratory system and mediastinum; wedge resection; Lung disease; cost-effectiveness; Respiratory disease; Lung cancer; Radiosurgery; Surgical resection; Early stage; wedge resection; Malignant tumor; Radiotherapy; non-small cell lung carcinoma; Cancerology; Treatment; Surgery; Health economy; Bronchus disease; stereotactic body radiation therapy; Lobectomy; Comparative study; Cancer; Cost efficiency analysis; lung cancer; lobectomy; surgery
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.28131

BACKGROUND The traditional treatment for clearly operable (CO) patients with stage I non–small cell lung cancer (NSCLC) is lobectomy, with wedge resection (WR) and stereotactic body radiation therapy (SBRT) serving as alternatives in marginally operable (MO) patients. Given an aging population with an increasing prevalence of screening, it is likely that progressively more people will be diagnosed with stage I NSCLC, and thus it is critical to compare the cost‐effectiveness of these treatments. METHODS A Markov model was created to compare the cost‐effectiveness of SBRT with WR and lobectomy for MO and CO patients, respectively. Disease, treatment, and toxicity data were extracted from the literature and varied in sensitivity analyses. A payer (Medicare) perspective was used. RESULTS In the base case, SBRT (MO cohort), SBRT (CO cohort), WR, and lobectomy were associated with mean cost and quality‐adjusted life expectancies of $42,094/8.03, $40,107/8.21, $51,487/7.93, and $49,093/8.89, respectively. In MO patients, SBRT was the dominant and thus cost‐effective strategy. This result was confirmed in most deterministic sensitivity analyses as well as probabilistic sensitivity analysis, in which SBRT was most likely cost‐effective up to a willingness‐to‐pay of more than $500,000/quality‐adjusted life year. For CO patients, lobectomy was the cost‐effective treatment option in the base case (incremental cost‐effectiveness ratio of $13,216/quality‐adjusted life year) and in nearly every sensitivity analysis. CONCLUSIONS SBRT was nearly always the most cost‐effective treatment strategy for MO patients with stage I NSCLC. In contrast, for patients with CO disease, lobectomy was the most cost‐effective option. Cancer 2013;119:3123–3132. © 2013 American Cancer Society. Stereotactic body radiation therapy is nearly always the most cost‐effective treatment strategy for marginally operable patients who have stage I non–small cell lung cancer. In contrast, for patients with clearly operable disease, lobectomy is the most cost‐effective option.