Spacers in radiotherapy treatment of prostate cancer: Is reduction of toxicity cost-effective? - Abstract

BACKGROUND AND PURPOSE: To compare the cost-effectiveness of treating prostate cancer patients with intensity-modulated radiation therapy and a spacer (IMRT+S) versus IMRT-only without a spacer (IMRT-O).

MATERIALS AND METHODS: A decision-analytic Markov model was constructed to examine the effect of late rectal toxicity and compare the costs and quality-adjusted Life Years (QALYs) of IMRT-O and IMRT+S. The main assumption of this modeling study was that disease progression, genito-urinary toxicity and survival were equal for both comparators.

RESULTS: For all patients, IMRT+S revealed a lower toxicity than IMRT-O. Treatment follow-up and toxicity costs for IMRT-O and IMRT+S amounted to €1604 and €1444, respectively, thus saving €160 on the complication costs at an extra charge of €1700 for the spacer in IMRT+S. The QALYs yielded for IMRT-O and IMRT+S were 3.542 and 3.570, respectively. This results in an incremental cost-effectiveness ratio (ICER) of €55,880 per QALY gained. For a ceiling ratio of €80,000, IMRT+S had a 77% probability of being cost-effective.

CONCLUSION: IMRT+S is cost-effective compared to IMRT-O based on its potential to reduce radiotherapy-related toxicity.

Written by:
Vanneste BG, Pijls-Johannesma M, Van De Voorde L, van Lin EN, van de Beek K, van Loon J, Ramaekers BL, Lambin P.   Are you the author?
Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, The Netherlands; Health insurance company CZ, Tilburg, The Netherlands; Westdeutsches Protonentherapiezentrum Essen (WPE), Germany; Department of Urology, Maastricht University Medical Center+, The Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, The Netherlands.  

Reference: Radiother Oncol. 2015 Feb;114(2):276-81.
doi: 10.1016/j.radonc.2015.01.005

PubMed Abstract
PMID: 25616537

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