Cost-effectiveness Analysis of a Randomized Study Comparing Radiosurgery With Radiosurgery and Whole Brain Radiation Therapy in Patients With 1 to 3 Brain Metastases
Cost-effectiveness Analysis of a Randomized Study Comparing Radiosurgery With Radiosurgery and Whole Brain Radiation Therapy in Patients With 1 to 3 Brain Metastases
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DOI：
10.1097/coc.0b013e3182005a8f
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发表时间：
2012-02-01
影响因子：
2.6
通讯作者：
Swint, John Michael
中科院分区：
文献类型：
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作者：
Lal, Lincy S.;Byfield, Stacey DaCosta;Swint, John Michael
背景资料：在这项研究中，我们比较了2种治疗方案，并确定成本效益和cost-utility.Methods：我们进行了一项决策分析填充与脑转移患者的数据在一项并行试验随机立体定向放射外科手术（SRS）和观察或SRS和全脑放射治疗。结果包括实际挽救生命年（LYS）、质量调整生命年（QES）和增量成本效果比（ICER）。使用的成本是从医疗保健的角度和公用事业是通过时间权衡方法，使用10年，5年和1年的时间范围。进行了单因素敏感性分析，以确定决策分析模型的稳健性。与SRS和全脑放疗相比，SRS和观察不仅平均费用较高，（分别为74，000美元和119，000美元），但平均有效性也更高（分别为0.60 LYS和1.64 LYS），ICER为44，231美元/LYS或41，783美元/QALY（使用10年期捕获效用）。使用其他时间范围获取的效用实现了略高的ICER估计值（分别为43，280美元/QALY和44，064美元/QALY）。敏感性分析显示以下变量对ICER的影响最大：SRS和观察后递归划分分析2类中无复发的概率; SRS和观察后递归划分分析2类中存活并接受复发治疗的概率。与其他50，000至100，000美元/QALY成本效益范围内的干预措施相比，SRS和观察的应用，以及随后的复发性神经外科治疗，被证明是脑转移瘤的合理治疗方式。
Background: In this study, we compare 2 treatment options and determine cost-effectiveness and cost-utility.Methods: We carried out a decision analysis populated with data from patients with brain metastasis in a concurrent trial randomized to either stereotactic radiosurgery (SRS) and observation or SRS and whole brain radiation therapy. Outcomes included actual life years saved (LYS), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Costs used were from the healthcare perspective and utilities were captured through a time-trade-off method, using 10-year, 5-year, and 1-year time horizons. One-way sensitivity analyses were carried out to determine robustness of the decision analysis model.Results: Compared with SRS and whole brain radiation therapy, SRS and observation not only had a higher average cost ($74,000 vs $119,000, respectively) but also a higher average effectiveness (0.60 LYS vs 1.64 LYS, respectively) with an ICER of $44,231/LYS or $41,783/QALY (with utilities captured using a 10-year horizon). Slightly higher ICER estimates were achieved with utilities captured using the other time horizons ($43,280/QALY and $44,064/QALY, respectively). Sensitivity analysis showed that the following variables had the highest impact on the ICER: probability of no recurrence in recursive-partitioning analysis class 2 after SRS and observation; probability of being alive after SRS and observation in recursive-partitioning analysis class 2 and being treated for recurrence.Conclusions: Compared with other interventions in the $50,000 to $100,000/QALY cost-effectiveness range, the application of SRS and observation, with subsequent neurosurgical management of recurrences, is shown to be a reasonable treatment modality for brain metastases.