Cost-effectiveness analysis of stereotactic body radiation therapy versus intensity-modulated radiation therapy: an emerging initial radiation treatment option for organ-confined prostate cancer.

PURPOSE The purpose of this study is to compare the cost-effectiveness of two external beam radiation therapy techniques for treatment of low- to intermediate-risk prostate cancer: stereotactic body radiation therapy (SBRT) and intensity-modulated radiation therapy (IMRT). MATERIALS AND METHODS A Markov decision analysis model with probabilistic sensitivity analysis was designed with the various disease states of a 70-year-old patient with organ-confined prostate cancer to evaluate the cost-effectiveness of two external beam radiation treatment options. RESULTS The Monte Carlo simulation revealed that the mean cost and quality-adjusted life-years (QALYs) for SBRT and IMRT were $22,152 and 7.9 years and $35,431 and 7.9 years, respectively. The sensitivity analysis revealed that if the SBRT cohort experienced a decrease in quality of life of 4% or a decrease in efficacy of 6%, then SBRT would no longer dominate IMRT in cost-effectiveness. In fact, with these relaxed assumptions for SBRT, the incremental cost-effectiveness ratio of IMRT met the societal willingness to pay threshold of $50,000 per QALY. CONCLUSION Compared with IMRT, SBRT for low- to intermediate-risk prostate cancer has great potential cost savings for our health care system payers and may improve access to radiation, increase patient convenience, and boost quality of life for patients. Our model suggests that the incremental cost-effectiveness ratio of IMRT compared with SBRT is highly sensitive to quality-of-life outcomes, which should be adequately and comparably measured in current and future prostate SBRT studies.

[1]  James D Brooks,et al.  Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer. , 2012, International journal of radiation oncology, biology, physics.

[2]  M. Bremer.  [Phase I dose-escalation study of stereotactic body radiation therapy for low- and intermediate-risk prostate cancer]. , 2012, Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al].

[3]  I. Hsu,et al.  Stereotactic body radiotherapy as monotherapy or post-external beam radiotherapy boost for prostate cancer: technique, early toxicity, and PSA response. , 2012, International journal of radiation oncology, biology, physics.

[4]  A. Kibel.  Active Surveillance Compared With Initial Treatment for Men With Low-Risk Prostate Cancer: A Decision Analysis: Hayes JH, Ollendorf DA, Pearson SD, et al (Harvard Med School, Boston, MA; et al) JAMA 304:2373-2380, 2010 § , 2011 .

[5]  C. King.  Stereotactic body radiotherapy for prostate cancer: current results of a phase II trial. , 2011, Frontiers of radiation therapy and oncology.

[6]  Arturo Molina,et al.  Abiraterone and increased survival in metastatic prostate cancer. , 2011, The New England journal of medicine.

[7]  S. Lipsitz,et al.  Cost implications of the rapid adoption of newer technologies for treating prostate cancer. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  N. Aronson,et al.  Outcomes of Sipuleucel-T Therapy , 2011 .

[9]  Eric J Feuer,et al.  Projections of the cost of cancer care in the United States: 2010-2020. , 2011, Journal of the National Cancer Institute.

[10]  C. King,et al.  Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes , 2011, Radiation oncology.

[11]  M. Chung,et al.  Comparative Evaluation of Radiation Treatments for Clinically Localized Prostate Cancer: An Updated Systematic Review , 2010, Annals of Internal Medicine.

[12]  C. Lawton,et al.  Randomized Trial Comparing Conventional-Dose With High-Dose Conformal Radiation Therapy in Early-Stage Adenocarcinoma of the Prostate: Long-Term Results From Proton Radiation Oncology Group/American College of Radiology 95-09 , 2011 .

[13]  C. Lawton.  Active Surveillance Compared With Initial Treatment for Men With Low-Risk Prostate Cancer: A Decision Analysis , 2011 .

[14]  P. Kantoff,et al.  Sipuleucel-T immunotherapy for castration-resistant prostate cancer. , 2010, The New England journal of medicine.

[15]  Andrea Bezjak,et al.  Stereotactic body radiation therapy for inoperable early stage lung cancer. , 2010, JAMA.

[16]  Milton C Weinstein,et al.  Comparative effectiveness and health care spending--implications for reform. , 2010, The New England journal of medicine.

[17]  L. Gaspar,et al.  Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  J. Brooks,et al.  Stereotactic body radiotherapy for localized prostate cancer: interim results of a prospective phase II clinical trial. , 2009, International journal of radiation oncology, biology, physics.

[19]  Lei Dong,et al.  Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. , 2008, International journal of radiation oncology, biology, physics.

[20]  William Speier,et al.  Is proton beam therapy cost effective in the treatment of adenocarcinoma of the prostate? , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  A Daşu,et al.  Is the alpha/beta value for prostate tumours low enough to be safely used in clinical trials? , 2007, Clinical oncology (Royal College of Radiologists (Great Britain)).

[22]  J. Beck,et al.  Using decision analysis to determine the cost-effectiveness of intensity-modulated radiation therapy in the treatment of intermediate risk prostate cancer. , 2006, International journal of radiation oncology, biology, physics.

[23]  P. Albertsen.  Utilities for Prostate Cancer Health States in Men Aged 60 and Older , 2006 .

[24]  H. Scher,et al.  Second-line chemotherapy for prostate cancer: patient characteristics and survival. , 2005, Clinical prostate cancer.

[25]  Robert D Timmerman,et al.  A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. , 2005, International journal of radiation oncology, biology, physics.

[26]  M. Resnick,et al.  Survival of patients with hormone refractory prostate cancer in the prostate specific antigen era. , 2004, The Journal of urology.

[27]  M. P. Van Gellekom,et al.  How low is the alpha/beta ratio for prostate cancer? , 2003, International journal of radiation oncology, biology, physics.

[28]  P. Rubin,et al.  Effect of a short course of neoadjuvant hormonal therapy on the response to subsequent androgen suppression in prostate cancer patients with relapse after radiotherapy: a secondary analysis of the randomized protocol RTOG 86-10. , 2002, International journal of radiation oncology, biology, physics.

[29]  Michael J. Zelefsky,et al.  High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. , 2002, International journal of radiation oncology, biology, physics.

[30]  J. Moul,et al.  Adenocarcinoma of the prostate: an expensive way to die , 2002, Prostate Cancer and Prostatic Diseases.

[31]  Warren D. D'Souza,et al.  Is the α/β ratio for prostate cancer low? , 2001 .

[32]  Rick Chappell,et al.  Is α/β for prostate tumors really low? , 2001 .

[33]  J. Fowler,et al.  Is alpha/beta for prostate tumors really low? , 2001, International journal of radiation oncology, biology, physics.

[34]  W. D'Souza,et al.  Is the alpha/beta ratio for prostate cancer low? , 2001, International journal of radiation oncology, biology, physics.

[35]  Adalsteinn D. Brown,et al.  Cost-effectiveness of androgen suppression therapies in advanced prostate cancer. , 2000, Journal of the National Cancer Institute.

[36]  A Pollack,et al.  Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial. , 2000, International journal of radiation oncology, biology, physics.

[37]  D. Chan,et al.  Natural History of Progression After PSA Elevation Following Radical Prostatectomy , 1999 .

[38]  D J Brenner,et al.  Fractionation and protraction for radiotherapy of prostate carcinoma. , 1999, International journal of radiation oncology, biology, physics.

[39]  J. Ware,et al.  Health-related quality of life among patients with metastatic prostate cancer. , 1997, Urology.

[40]  S. Homan,et al.  Determining Transition Probabilities , 1994, Medical decision making : an international journal of the Society for Medical Decision Making.

[41]  J R Beck,et al.  Markov Models in Medical Decision Making , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[42]  M. Barry,et al.  A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Prostate Patient Outcomes Research Team. , 1993, JAMA.