© 2003 by Oxford University Press
Journal of the National Cancer Institute, Vol. 95, No. 3, 222-229,
February 5, 2003
© 2003 Oxford University Press
ARTICLE |
Single- Versus Multiple-Fraction Radiotherapy in Patients With Painful Bone Metastases: Cost–Utility Analysis Based on a Randomized Trial
For the Dutch Bone Metastasis Study Group
Affiliations of authors: W. B. van den Hout, J. Kievit (Department of Medical Decision Making), Y. M. van der Linden, E. Steenland (Department of Clinical Oncology), Leiden University Medical Center, Leiden, The Netherlands; R. G. J. Wiggenraad, Department of Radiotherapy, Haaglanden Medical Center, The Hague, The Netherlands; H. de Haes, Department of Medical Psychology, University of Amsterdam, Amsterdam, The Netherlands; J. W. H. Leer, Joint Center for Radiation Oncology Arnhem-Nijmegen, The Netherlands.
Correspondence to: Wilbert B. van den Hout, Ph.D., Department of Medical Decision Making, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands (e-mail: W.B.van_den_Hout{at}LUMC.NL).
Background: Radiotherapy is an effective palliative treatment for cancer patients with painful bone metastases. Although single- and multiple-fraction radiotherapy are thought to provide equal palliation, which treatment schedule provides better value for the money is unknown. We compared quality-adjusted life expectancy (the overall valuation of the health of the patients) and societal costs for patients receiving either single- or multiple-fraction radiotherapy. Methods: A societal cost–utility analysis was performed on a Dutch randomized, controlled trial of 1157 patients with painful bone metastases that compared pain responses and quality of life from a single-fraction treatment schedule of 8 Gy with a treatment schedule of six fractions of 4 Gy each. The societal values of life expectancies were assessed with the EuroQol classification system (EQ-5D) questionnaire. A subset of 166 patients also answered additional questionnaires to estimate nonradiotherapy and nonmedical costs. Statistical tests were two-sided. Results: Comparing the single- and multiple-fraction radiotherapy schedules, no differences were found in life expectancy (43.0 versus 40.4 weeks, P = .20) or quality-adjusted life expectancy (17.7 versus 16.0 weeks, P = .21). The estimated cost of radiotherapy, including retreatments and nonmedical costs, was statistically significantly lower for the single-fraction schedule than for the multiple-fraction schedule ($2438 versus $3311, difference = $873, 95% confidence interval [CI] on the difference = $449 to $1297; P<.001). The estimated difference in total societal costs was larger, also in favor of the single-fraction schedule, but it was not statistically significant ($4700 versus $6453, difference = $1753, 95% CI on the difference = –$99 to $3604; P = .06). For willingness-to-pay between $5000 and $40 000 per quality-adjusted life year, the single-fraction schedule was statistically significantly more cost-effective than the multiple-fraction schedule (P
.05). Conclusions: Compared with multiple-fraction radiotherapy, single-fraction radiotherapy provides equal palliation and quality of life and has lower medical and societal costs, at least in The Netherlands. Therefore, single-fraction radiotherapy should be considered as the palliative treatment of choice for cancer patients with painful bone metastases.
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