A new paper in the Journal of Oncology Practice has attempted to compare the cost-effectiveness of stereotactic body radiation therapy (SBRT) to that of intensity-modulated radiation therapy (IMRT) in the treatment of men with low- to intermediate-risk prostate cancer.
Hodges et al. applied a Markov decision analysis model to the potential clinical states of a 70-year-old patient with organ-confined prostate cancer to evaluate the cost-effectiveness of the two differing type of external beam radiation treatment, with the following resulsts:
- For IMRT
- Average (mean) cost of treatment was $35,431.
- Average (mean) number of quality-adjusted life-years (QALYs) was 7.9 years.
- For SBRT
- Average (mean) cost of treatment was $22,152.
- Average (mean) number of QALYs was 7.9 years.
- Sensitivity analysis suggested that SBRT would no longer dominate IMRT in cost-effectiveness if
- Men treated with SBRT experienced a decrease in quality of life of 4 percent compared to those treated with IMRT.
- Men treated with SBRT experienced a decrease in therapeutic efficacy of 6 percent compared to those treated with IMRT.
Hodges et al. conclude that SBRT has considerable potential for cost saving compared to IMRT in the treatment of men with low- to intermediate-risk prostate cancer (at least within the US health care system) and may therefore improve access to radiation, increase patient convenience, and boost quality of life for patients. However, they also note carefully that (based on their model) the incremental cost-effectiveness IMRT compared with SBRT is very sensitive to quality-of-life outcomes. This implies that quality of life outcomes do need to be carefully assessed and compared to those for men treated by IMRT in studies of SBRT in the treatment of men with low- and intermediate risk prostate cancer.