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Rezapour A, Gholampour H, Barzegar M, Irandoust K, Afshari S, Arabloo J, Mahmoodi R, Sarabi Asiabar A, Atefimanesh P, Ghafoori MH. Economic evaluation of stereotactic radiotherapy and stereotactic radiosurgery technologies in the treatment of cancers: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:899-922. [PMID: 38738558 DOI: 10.1080/14737167.2024.2353727] [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: 10/05/2023] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION This systematic review study investigated the cost-effectiveness of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) for treatment of various types of cancers. METHODS PubMed, Scopus, and Web of Science were searched from 30 December 1990 to 1 January 2023. The entered studies were screened in accordance with the inclusion criteria. The inclusion criteria encompassed all types of economic evaluation studies that investigated SRT/SRS technologies in the treatment of various cancers. RESULTS A total of 47 articles were included in the review. The findings suggest that the use of Linear accelerator technology for the treatment of lung cancer (8 out of 12 studies) and prostate cancer (4 out of 5 studies) was a cost-effective strategy. Linear accelerator was found to be cost-effective in the treatment of liver metastases and liver cancer (2 out of 5 studies). All of the included studies that used Gamma Knife technology in brain metastases reported Gamma-Knife was a cost-effective treatment. Furthermore, in the treatment of prostate and liver cancer, proton therapy was identified as a cost-effective option than other treatments. CONCLUSIONS This study confirms that SRT/SRS is a cost-effective procedure for the treatment of various types of cancers. Therefore, it is recommended to use SRT/SRS technology for optimal use of resources.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Hanie Gholampour
- Department of Health Economics, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Barzegar
- Department of English Language Teaching, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Irandoust
- Department of Health Economics, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Afshari
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Jalal Arabloo
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Mahmoodi
- Department of Health Economics School of Management and Medical Informatics, Tabriz University of Medical Science, Tabriz, Iran
| | - Ali Sarabi Asiabar
- Minimally Invasive Surgery Research center, Iran University of Medical Sciences, Tehran, Iran
| | - Pezhman Atefimanesh
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Ghafoori
- Department of Health Economics, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Sher DJ, Chen RC. The Cost-Effectiveness of Consolidative Radiation Therapy in Oligometastatic Disease: High-Value Proposition or Wishful Thinking? Int J Radiat Oncol Biol Phys 2022; 114:824-826. [DOI: 10.1016/j.ijrobp.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022]
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Guggenbickler AM, Barr HK, Hoch JS, Dewa CS. Rapid Review of Real-World Cost-Effectiveness Analyses of Cancer Interventions in Canada. Curr Oncol 2022; 29:7285-7304. [PMID: 36290851 PMCID: PMC9600856 DOI: 10.3390/curroncol29100574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Cost-effectiveness analysis (CE Analysis) provides evidence about the incremental gains in patient outcomes costs from new treatments and interventions in cancer care. The utilization of "real-world" data allows these analyses to better reflect differences in costs and effects for actual patient populations with comorbidities and a range of ages as opposed to randomized controlled trials, which use a restricted population. This rapid review was done through PubMed and Google Scholar in July 2022. Relevant articles were summarized and data extracted to summarize changes in costs (in 2022 CAD) and effectiveness in cancer care once funded by the Canadian government payer system. We conducted statistical analyses to examine the differences between means and medians of costs, effects, and incremental cost effectiveness ratios (ICERs). Twenty-two studies were selected for review. Of those, the majority performed a CE Analysis on cancer drugs. Real-world cancer drug studies had significantly higher costs and effects than non-drug therapies. Studies that utilized a model to project longer time-horizons saw significantly smaller ICER values for the treatments they examined. Further, differences in drug costs increased over time. This review highlights the importance of performing real-world CE Analysis on cancer treatments to better understand their costs and impacts on a general patient population.
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Affiliation(s)
- Andrea M. Guggenbickler
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Heather K. Barr
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
- Center for Healthcare Policy and Research, University of California, Davis, CA 95820, USA
- Correspondence:
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA 95817, USA
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Verma V, Yegya-Raman N, Sprave T, Han G, Kantarjian HM, Welsh JW, Chang JY, Lin SH. A Systematic Review of Cost-Effectiveness Studies of Stereotactic Radiotherapy for Cancer Oligometastases. Int J Radiat Oncol Biol Phys 2022; 114:977-988. [PMID: 35675852 DOI: 10.1016/j.ijrobp.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/20/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE It is crucial to economically justify the use of promising therapies such as stereotactic ablative radiotherapy (SABR) for oligometastatic disease (OMD). The goal of this systematic review was to summatively evaluate publications that analyzed the cost-effectiveness of SABR for OMD. METHODS AND MATERIALS Using PRISMA-guided methodology, PubMed and EMBASE were searched for modeling-based cost effectiveness (CE) studies for various forms of limited metastatic disease. Only full publications that specifically compared SABR with a systemic therapy-based approach were included. RESULTS Of 9 studies, 4 pertained to OMD with mixed histologies, 2 to oligometastatic non-small cell lung cancer, 1 to pulmonary OMD, 1 to liver OMD, and 1 to low-volume oligorecurrent castration-sensitive prostate cancer. All but one investigation illustrated that SABR was cost-effective for the studied population (or a subpopulation); of these studies, the incremental CE ratios (ICERs) for SABR (when reported) ranged from $28,000/quality-adjusted life-year (QALY) to $55,000/QALY. Of studies that reported the probability of SABR being cost-effective at common willingness-to-pay values, the median (range) probability of achieving CE was roughly 61% (30-88%) at a $50,000/QALY threshold and 78% (31%-100%) at a $100,000/QALY threshold. CONCLUSIONS The available evidence suggests that SABR is a cost-effective approach for OMD, which has implications for value-based oncologic practice and construction of future health policies. However, re-assessment is required in the context of modern systemic therapies (e.g. immunotherapy) as well as long-term follow-up of existing and newly reported randomized trials. Prudent patient selection remains the single most important factor influencing the CE of SABR for OMD.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Nikhil Yegya-Raman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Tanja Sprave
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hagop M Kantarjian
- Department of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - James W Welsh
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Joe Y Chang
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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Lourenco RDA, Khoo T, Crothers A, Haas M, Montgomery R, Ball D, Bressel M, Siva S. Cost-Effectiveness of Single Versus Multifraction SABR for Pulmonary Oligometastases: The SAFRON II Trial. Int J Radiat Oncol Biol Phys 2022; 114:968-976. [DOI: 10.1016/j.ijrobp.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 01/19/2023]
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Olson RA, LaPointe V, Benny A, Chan M, Lefresne S, McKenzie M. Evaluation of Patient-Reported Outcome Differences by Radiotherapy Techniques for Bone Metastases in A Population-Based Healthcare System. Curr Oncol 2022; 29:2073-2080. [PMID: 35323367 PMCID: PMC8947740 DOI: 10.3390/curroncol29030167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/25/2022] Open
Abstract
We assessed whether advanced RT techniques were associated with differences in patient-reported outcomes (PROs). Patients with bone metastases who completed the brief pain inventory (BPI) before and after RT were identified, and RT technique was categorized as simple (e.g., parallel opposed pair) or advanced (e.g., 3D-conformal RT (3DCRT), intensity-modulated RT (IMRT), or stereotactic ablative RT (SABR)). Pain response and patient-reported interference on quality of life secondary to pain was compared. A total of 1712 patients completed the BPI. From 2017−2021, the rate of advanced RT technique increased significantly (p < 0.001; 2.4%, 2.4%, 9.7%, 5.5%, 9.3%), with most advanced techniques consisting of IMRT, and only 7% of advanced techniques were SABR. Comparing simple vs. advanced technique, neither the complete pain response (12.3% vs. 11.4%; p = 0.99) nor the partial pain response (50.0% vs. 51.8%; p = 0.42) was significantly different. There was no significant patient-reported difference in pain interfering with general activity, mood, walking ability, normal work, relationships, sleep, or enjoyment of life. Given that there is increasing utilization of advanced RT techniques, there is further need for randomized trials to assess their benefits given the increased cost and inconvenience to patients.
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Affiliation(s)
| | - Vincent LaPointe
- BC Cancer, Vancouver, Vancouver, BC V6T 1Z4, Canada; (V.L.); (M.C.); (S.L.); (M.M.)
| | - Alex Benny
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Matthew Chan
- BC Cancer, Vancouver, Vancouver, BC V6T 1Z4, Canada; (V.L.); (M.C.); (S.L.); (M.M.)
| | - Shilo Lefresne
- BC Cancer, Vancouver, Vancouver, BC V6T 1Z4, Canada; (V.L.); (M.C.); (S.L.); (M.M.)
| | - Michael McKenzie
- BC Cancer, Vancouver, Vancouver, BC V6T 1Z4, Canada; (V.L.); (M.C.); (S.L.); (M.M.)
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