Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling. (August 2021)

• Record Type: Journal Article
• Authors: Hehakaya, Charisma; van der Voort van Zyp, Jochem R.N.; Vanneste, Ben G.L.; Grutters, Janneke P.C.; Grobbee, Diederick E.; Verkooijen, Helena M.; Frederix, Geert W.J.
• Is Part Of: Radiotherapy and oncology. Volume 161(2021)
• Page Start: 74
• Page End: 82
• Publication Date: 2021-08
• Subjects: MRI-guided radiotherapy -- MR-Linac -- Localized prostate cancer -- Early cost-effectiveness; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.05.022
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: The ongoing technical development challenges to define a clear value proposition. Results offer insight into key elements for investment choices and future studies. MR-Linac is found to be cost-effective compared to EBRT 20 and 39 fractions. Comparisons with EBRT 5 fractions and LDR brachytherapy are most challenging. Abstract: Background and purpose: 1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Clinical evidence is lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy. Materials and methods: A state transition model was developed for men with localized prostate cancer. Complication rates such as grade ≥2 urinary, grade ≥2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR-Linac to be cost-effective, while holding other outcomes such as biochemical progression and mortality constant. One-way sensitivity analyses were performed to outline uncertainty outcomes. Results: At €6460 per patient, no reductions in complications were needed to consider MR-Linac cost-effective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression. Conclusions: MR-Linac is found to be cost-effective compared to 20 and 39 fractions EBRT at baseline. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs.