Brachytherapy provides comparable outcomes and improved cost-effectiveness in the treatment of low/intermediate prostate cancer - Abstract

PURPOSE: To evaluate the cost-effectiveness and outcomes of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy compared with intensity-modulated radiation therapy (IMRT) in patients with low/intermediate risk of prostate cancer.

METHODS AND MATERIALS: One thousand three hundred twenty-eight patients with low or intermediate risk of prostate cancer were treated with LDR (n=207), HDR with four fractions (n=252), or IMRT (n=869) between January 1992 and December 2008. LDR patients were treated with palladium seeds to a median dose of 120Gy, whereas HDR patients were treated to a median dose 38.0Gy (four fractions). IMRT patients received 42-44 fractions with a median dose of 75.6Gy. Clinical outcomes were compared, including biochemical failure, cause-specific survival, and overall survival.

RESULTS: Overall, no differences in 5-year biochemical control (BC) or cause-specific survival were noted among treatment modalities. The calculated reimbursement for LDR brachytherapy, HDR brachytherapy with four fractions, and IMRT was $9,938; $17,514; and $29,356, respectively. HDR and LDR brachytherapy were statistically less costly to Medicare and the institution than IMRT (p< 0.001), and LDR brachytherapy was less costly than HDR brachytherapy (p=0.01 and p< 0.001). Incremental cost-effectiveness ratios for cost to Medicare for BC with IMRT were $4045 and $2754 per percent of BC for LDR and HDR brachytherapy, respectively. Incremental cost-effectiveness ratio using institutional cost comparing IMRT with LDR and HDR brachytherapy was $4962 and $4824 per 1% improvement in BC.

CONCLUSIONS: In this study of patients with low and intermediate risk of prostate cancer, comparable outcomes at 5 years were noted between modalities with increased costs associated with IMRT.

Written by:
Shah C, Lanni TB Jr, Ghilezan MI, Gustafson GS, Marvin KS, Ye H, Vicini FA, Martinez AA.   Are you the author?
Department of Radiation Oncology, Oakland University William Beaumont Hospital, Royal Oak, MI.

Reference: Brachytherapy. 2012 Jun 22. Epub ahead of print.
doi: 10.1016/j.brachy.2012.04.002

PubMed Abstract
PMID: 22728157 Prostate Cancer Section