Relative cost-effectiveness of SBRT and IMRT in treatment of localized prostate cancer

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.

3 Responses

  1. SBRT with real-time target volume tracking and prescribed dose plan beam adjustment before beam-on results in the lowest risk of toxicity to surrounding critical structures. Result is high quality of life outcome. However, SBRT is simply a general treatment term. Patients need to understand treatment details to make an informed choice.

    Biological control is important, quality of life is important, and cost is important. SBRT offers opportunities in all these areas with the right combination of technology and treatment plan. Patients can find this information by searching PubMed using the terms “prostate cancer, SBRT”. Read studies carefully and compare outcome by equipment and principal study author. Include every modality (surgery, IMRT, brachytherapy, etc.) when evaluating options. A patient can then select a therapy that is most appropriate for them.

    Wish all patients good luck with their treatment of choice.

  2. A word of caution to those not used to using systems like PubMed … You are not often going to find detailed studies in which differing treatments are compared “head to head” in patients like you. Such studies are very few and far between, so the perspectives of specific groups of authors on the interpretation of the available data can vary considerably. It takes experience to sort the wheat from the chaff.

  3. Thanks for your word of caution to readers, it is well advised.

    Patient lack access to complete articles is a social issue with many opinions. Caution is advised to all readers as articles in medical and scientific journals are not perfect, can have errors, can lack good controls, can reflects the biases of the authors, the reviewers, the editors, etc. Some authors publish what is effectively the same study and data in more than one journal, e.g., in an open access journal with different wording to avoid copyright issues. This is the best we have and with time readers can sort out the wheat from the chaff. There is only one way to make an informed choice and that is to be informed.

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