Spacers in radiotherapy treatment of prostate cancer: Is reduction of toxicity cost-effective?

• Published in: Radiotherapy and oncology Vol. 114; no. 2; pp. 276 - 281
• Main Authors: Vanneste, Ben G.L, Pijls-Johannesma, Madelon, Van De Voorde, Lien, van Lin, Emile N, van de Beek, Kees, van Loon, Judith, Ramaekers, Bram L, Lambin, Philippe
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.02.2015
• Subjects: Cost-Benefit Analysis; Cost-effectiveness; Decision Support Techniques; Disease Progression; Hematology, Oncology and Palliative Medicine; Humans; Male; Markov Chains; Prostate cancer; Prostatic Neoplasms - economics; Prostatic Neoplasms - radiotherapy; Quality-Adjusted Life Years; Radiation Injuries - economics; Radiation Injuries - etiology; Radiation Injuries - prevention & control; Radiotherapy; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - economics; Radiotherapy, Intensity-Modulated - methods; Spacer; Toxicity-reduction; Toxicity-reduction; Radiotherapy; Prostate cancer; Cost-effectiveness; Spacer
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2015.01.005

Abstract Background and purpose To compare the cost-effectiveness of treating prostate cancer patients with intensity-modulated radiation therapy and a spacer (IMRT+S) versus IMRT-only without a spacer (IMRT-O). Materials and methods A decision-analytic Markov model was constructed to examine the effect of late rectal toxicity and compare the costs and quality-adjusted Life Years (QALYs) of IMRT-O and IMRT+S. The main assumption of this modeling study was that disease progression, genito-urinary toxicity and survival were equal for both comparators. Results For all patients, IMRT+S revealed a lower toxicity than IMRT-O. Treatment follow-up and toxicity costs for IMRT-O and IMRT+S amounted to €1604 and €1444, respectively, thus saving €160 on the complication costs at an extra charge of €1700 for the spacer in IMRT+S. The QALYs yielded for IMRT-O and IMRT+S were 3.542 and 3.570, respectively. This results in an incremental cost-effectiveness ratio (ICER) of €55,880 per QALY gained. For a ceiling ratio of €80,000, IMRT+S had a 77% probability of being cost-effective. Conclusion IMRT+S is cost-effective compared to IMRT-O based on its potential to reduce radiotherapy-related toxicity.