Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer. (May 2022)

• Record Type: Journal Article
• Authors: Witlox, Willem J.A.; Ramaekers, Bram L.T.; Lacas, Benjamin; Le Pechoux, Cecile; Sun, Alexander; Wang, Si-Yu; Hu, Chen; Redman, Mary; van der Noort, Vincent; Li, Ning; Guckenberger, Matthias; van Tinteren, Harm; Hendriks, Lizza E.L.; Groen, Harry J.M.; Joore, Manuela A.; De Ruysscher, Dirk K.M.
• Is Part Of: Radiotherapy and oncology. Volume 170(2022)
• Page Start: 95
• Page End: 101
• Publication Date: 2022-05
• Subjects: Prophylactic cranial irradiation -- Stage III non-small cell lung cancer -- Cost-effectiveness analysis -- Cohort partitioned survival model; 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.2022.02.036
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: The cost-effectiveness of PCI compared to no PCI was assessed in stage III NSCLC. A cohort partitioned survival model was developed including five health states. PCI was more effective (0.443 QALYs) and costly (€10, 123) than no PCI. The probability of PCI being cost-effective was 93%. Abstract: Introduction: In stage III non-small cell lung cancer (NSCLC), prophylactic cranial irradiation (PCI) reduces the brain metastases incidence and prolongs the progression-free survival without improving overall survival. PCI increases the risk of toxicity and is currently not adopted in routine care. Our objective was to assess the cost-effectiveness of PCI compared with no PCI in stage III NSCLC from a Dutch societal perspective. Methods: A cohort partitioned survival model was developed based on individual patient data from three randomized phase III trials ( N = 670). Quality-adjusted life years (QALYs) and costs were estimated over a lifetime time horizon. A willingness-to-pay (WTP) threshold of €80, 000 per QALY was adopted. Sensitivity and scenario analyses were performed to address parameter uncertainty and to explore what parameters had the greatest impact on the cost-effectiveness results. Results: PCI was more effective and costly (0.443 QALYs, €10, 123) than no PCI, resulting in an incremental cost-effectiveness ratio (ICER) of €22, 843 per QALY gained. The probability of PCI being cost-effective at a WTP threshold of €80, 000 per QALY was 93%. The probability of PCI gaining three and six additional months of life were 76% and 56%. The scenario analysis adding durvalumab increased the ICER to €35, 159 per QALY gained. Using alternative survival distributions had little impact on the ICER. Assuming fewer PCI fractions and excluding indirect costs decreased the ICER to €18, 263 and €5554 per QALY gained. Conclusion: PCI is cost-effective compared to no PCI in stage III NSCLC, and could therefore, from a cost-effectiveness perspective, be considered in routine care.