A decision model to estimate the cost-effectiveness of intensity modulated radiation therapy (IMRT) compared to three dimensional conformal radiation therapy (3DCRT) in patients receiving radiotherapy to the prostate bed

• Published in: Radiotherapy and oncology Vol. 112; no. 2; pp. 187 - 193
• Main Authors: Carter, Hannah E, Martin, Andrew, Schofield, Deborah, Duchesne, Gillian, Haworth, Annette, Hornby, Colin, Sidhom, Mark, Jackson, Michael
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-08-2014
• Subjects: Australia; Cost; Cost-Benefit Analysis; Decision model; Decision Support Techniques; Effectiveness; Hematology, Oncology and Palliative Medicine; Humans; IMRT; Male; Markov Chains; Prostate; Prostate cancer; Prostatectomy; Prostatic Neoplasms - economics; Prostatic Neoplasms - radiotherapy; Quality-Adjusted Life Years; Radiotherapy, Adjuvant; Radiotherapy, Conformal - economics; Radiotherapy, Conformal - methods; Radiotherapy, Intensity-Modulated - economics; Radiotherapy, Intensity-Modulated - methods; Australia; Prostatectomy; Effectiveness; IMRT; Decision model; Cost; Prostate cancer
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2014.03.020

Abstract Background Intensity modulated radiation therapy (IMRT) is a radiation therapy technology that facilitates the delivery of an improved dose distribution with less dose to surrounding critical structures. This study estimates the longer term effectiveness and cost-effectiveness of IMRT in patients post radical prostatectomy. Methods A Markov decision model was developed to calculate the incremental quality adjusted life years (QALYs) and costs of IMRT compared with three dimensional conformal radiation therapy (3DCRT). Costs were estimated from the perspective of the Australian health care system. Results IMRT was both more effective and less costly than 3DCRT over 20 years, with an additional 20 QALYs gained and over $1.1 million saved per 1000 patients treated. This result was robust to plausible levels of uncertainty. Conclusions IMRT was estimated to have a modest long term advantage over 3DCRT in terms of both improved effectiveness and reduced cost. This result was reliant on clinical judgement and interpretation of the existing literature, but provides quantitative guidance on the cost effectiveness of IMRT whilst long term trial evidence is awaited.