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Perrier L, Balusson F, Morelle M, Castelli J, Thariat J, Benezery K, Hasbini A, Gery B, Berger A, Liem X, Guihard S, Chapet S, Thureau S, Auberdiac P, Pommier P, Ruffier A, Devillers A, Oger E, Campillo-Gimenez B, de Crevoisier R. Cost-effectiveness of weekly adaptive radiotherapy versus standard IMRT in head and neck cancer alongside the ARTIX trial. Radiother Oncol 2024; 193:110116. [PMID: 38316193 DOI: 10.1016/j.radonc.2024.110116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/21/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND PURPOSE We performed a cost-effectiveness analysis (CEA) comparing an adaptive radiotherapy (ART) strategy, based on weekly replanning, aiming to correct the parotid gland overdose during treatment and expecting therefore to decrease xerostomia, when compared to a standard IMRT. MATERIALS AND METHODS We conducted the ARTIX trial, a randomized, parallel-group, multicentric study comparing a systematic weekly replanning ART to a standard IMRT. The primary endpoint was the frequency of xerostomia at 12 months, measured by stimulating salivary flow with paraffin. The CEA was designed alongside the ARTIX trial which was linked to the French national health data system (SNDS). For each patient, healthcare consumptions and costs were provided by the SNDS. The reference case analysis was based on the primary endpoint of the trial. Sensitivity and scenario analyses were performed. RESULTS Of the 129 patients randomly assigned between 2013 and 2018, only 2 records were not linked to the SNDS, which provides a linkage proportion of 98.4%. All of the other 127 records were linked with good to very good robustness. On the intent-to-treat population at 12 months, mean total costs per patient were €41,564 (SD 23,624) and €33,063 (SD 16,886) for ART and standard IMRT arms, respectively (p = 0.033). Incremental cost effectiveness ratio (ICER) was €162,444 per xerostomia avoided. At 24 months, ICER was €194,521 per xerostomia avoided. For both progression-free and overall survival, ART was dominated by standard IMRT. CONCLUSION The ART strategy was deemed to be not cost-effective compared with standard IMRT for patients with locally advanced oropharyngeal cancer.
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Affiliation(s)
- Lionel Perrier
- Univ Lyon, Leon Berard Cancer Center, GATE UMR 5824, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France; Human and Social Science Department, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France.
| | - Frédéric Balusson
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Magali Morelle
- Univ Lyon, Leon Berard Cancer Center, GATE UMR 5824, 28 Prom. Léa et Napoléon Bullukian F-69008, Lyon, France
| | - Joël Castelli
- Department of Radiotherapy, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, IN2P3/ENISAEN-CNRS, Normandie Université, Caen, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Avenue de Valombrose F06000, Nice, France
| | - Ali Hasbini
- Radiotherapy, Clinique Pasteur-Lanroze, 32 Rue Auguste Kervern F29200, Brest, France
| | - Bernard Gery
- Department of Radiation Oncology, Centre François Baclesse, Laboratoire de Physique Corpusculaire, IN2P3/ENISAEN-CNRS, Normandie Université, Caen, France
| | - Antoine Berger
- Department of Radiotherapy, CHU Poitiers, 2 Rue de la Milétrie F86000, Poitiers, France
| | - Xavier Liem
- Academic Department of Radiation Oncology and Brachytherapy, Oscar Lambret Center, Lille, France
| | - Sébastien Guihard
- Department of Radiotherapy, ICANS, 17 rue Albert Calmette F67033, Strasbourg, France
| | - Sophie Chapet
- Department of Radiotherapy, Centre Jean-Bernard, institut inter-régional de cancérologie (ILC), CCS, 64, rue de Degré F-72000, Le Mans, France
| | - Sébastien Thureau
- Department of Radiotherapy, Centre Henri Becquerel, 1 Rue d'Amiens F76038, Rouen, France; Quantif LITIS EA 4108, University of Rouen, 22, Boulevard Gambetta F-76183, Rouen Cedex 1, France
| | - Pierre Auberdiac
- Radiotherapy, Clinique Claude Bernard, 1 rue du Père Colombier F81000, Albi, France
| | - Pascal Pommier
- Department of Radiotherapy, ICO-Angers, 15, rue André Boquel 49055, Angers cedex 02, France
| | - Amandine Ruffier
- Department of Radiotherapy, Centre Jean-Bernard, institut inter-régional de cancérologie (ILC), CCS, 64, rue de Degré F-72000, Le Mans, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Boris Campillo-Gimenez
- Department of Clinical Research, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France; Inserm, LTSI-UMR 1099, University of Rennes, F-35000, Rennes, France
| | - Renaud de Crevoisier
- Department of Radiotherapy, Centre Eugene Marquis, Avenue Bataille Flandres Dunkerques F35000, Rennes, France
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