© The Author 2006. Published by Oxford University Press.
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Cost–Utility Analysis of Short- Versus Long-Course Palliative Radiotherapy in Patients With Non–Small-Cell Lung Cancer
Affiliations of authors: Departments of Medical Decision Making (WBVDH) and Clinical Oncology (EMN), Leiden University Medical Center, Leiden, The Netherlands; Joint Center for Radiation Oncology Arnhem–Nijmegen (RADIAN), Arnhem, The Netherlands (GWPMK, JWHL)
Correspondence to: Wilbert B. van den Hout, PhD, Department of Medical Decision Making, J10-S, Leiden University Medical Center, PO Box 9600, 2300RC Leiden, The Netherlands (e-mail: w.b.van_den_hout{at}lumc.nl).
Background: Radiotherapy can effectively palliate the symptoms of poor-prognosis patients with non–small-cell lung cancer. However, controversy remains about whether short-course or more protracted radiotherapy schedules provide better value for the money. We conducted a societal cost–utility analysis of a Dutch multicenter randomized trial with 1-year follow-up that compared the efficacy of radiotherapy schedules consisting of 10 fractions of 3 Gy (10 x 3 Gy) versus two fractions of 8 Gy (2 x 8 Gy) in 297 patients with inoperable stage IIIA/B or stage IV non–small-cell lung cancer. this trial found that the 10 x 3–Gy group had better survival than the 2 x 8–Gy group. Methods: Lifetime quality-adjusted life-years (QALYs) were estimated using the EuroQol questionnaire. Lifetime societal costs were estimated using a model estimated based on data from cost questionnaires filled out by a subset of patients (n = 56). Differences were analyzed statistically using two-sided nonparametric bootstrapping. Results: Compared with the 2 x 8–Gy group, the 10 x 3–Gy group accrued statistically significantly more QALYs (20.0 versus 13.2 weeks; difference = 6.8 weeks, 95% confidence interval [CI] = 0.1 to 13.5 weeks, P = .05), which was mainly due to the statistically significantly better survival (38.1 versus 27.4 weeks; difference = 10.7 weeks, 95% CI = 0.9 to 20.6 weeks, P = .03) without a statistically significant difference with respect to the average valuation of health (P = .27). Total radiotherapy and radiotherapy-related costs were estimated at $5236 for the 10 x 3–Gy group and $2512 for the 2 x 8–Gy group (difference = $2724, 95% CI = $2501 to $2947, P<.001). The 39% increase in life expectancy in the 10 x 3–Gy group as compared with the 2 x 8–Gy group was associated with a 30% increase in survival-related nonradiotherapy costs ($11 254 versus $8651, difference $2602, 95% CI = –$357 to $5562, P = .09). The cost–utility ratio for the 10 x 3–Gy schedule versus the 2 x 8–Gy schedule was estimated at $40 900 per QALY (95% CI = $19 400 to $1 100 000 per QALY). Conclusions: In these poor-prognosis non–small-cell lung cancer patients, the estimated cost–utility ratio for the palliative 10 x 3–Gy schedule was acceptable according to current economic standards. However, the additional costs for the protracted schedule were justified not by improved quality of life but by longer survival.
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