Cost-effectiveness of stereotactic body radiation therapy versus video assisted thoracic surgery in medically operable stage I non-small cell lung cancer: A modeling study

Abstract

Objectives: Stage I non-small cell lung cancer (NSCLC) can be treated with either Stereotactic Body Radiotherapy (SBRT) or Video Assisted Thoracic Surgery (VATS) resection. To support decision making, not only the impact on survival needs to be taken into account, but also on quality of life, costs and cost-effectiveness. Therefore, we performed a cost-effectiveness analysis comparing SBRT to VATS resection with respect to quality adjusted life years (QALY) lived and costs in operable stage I NSCLC. Materials and methods: Patient level and aggregate data from eight Dutch databases were used to estimate costs, health utilities, recurrence free and overall survival. Propensity score matching was used to minimize selection bias in these studies. A microsimulation model predicting lifetime outcomes after treatment in stage I NSCLC patients was used for the cost-effectiveness analysis.Model outcomes for the two treatments were overall survival, QALYs, and total costs. We used a Dutch health care perspective with 1.5 % discounting for health effects, and 4 % discounting for costs, using 2018 cost data. The impact of model parameter uncertainty was assessed with deterministic and probabilistic sensitivity analyses. Results: Patients receiving either VATS resection or SBRT were estimated to live 5.81 and 5.86 discounted QALYs, respectively. Average discounted lifetime costs in the VATS group were €29,269 versus €21,175 for SBRT. Difference in 90-day excess mortality between SBRT and VATS resection was the main driver for the difference in QALYs. SBRT was dominant in at least 74 % of the probabilistic simulations. Conclusion: Using a microsimulation model to combine available evidence on survival, costs, and health utilities in a cost-effectiveness analysis for stage I NSCLC led to the conclusion that SBRT dominates VATS resection in the majority of simulations.

<p>Characteristics of Postoperative Pain After VATS and Pain-Related Factors: The Experience in National Cancer Center of China</p>

“…Without compromising short-term and long-term outcomes, VATS can provide several benefits to patients compared with traditional open thoracotomy. 11 Postsurgical pain is one of the most common surgical complications, despite the advances in understanding pain and the development of new modalities for pain management. 12 Several studies demonstrate that 41-69% of patients have experienced moderate-to-severe pain after operation.…”

Lack of an association between marital status and survival in patients receiving stereotactic body radiotherapy for early-stage non-small-cell lung cancer

“…The absence of such support negatively affects survival in unmarried patients treated with surgery. However, SBRT does not cause such a negative effect because it is minimally invasive and requires less hospital care or support than surgery [ 24 , 25 ]. Third, there was a difference in treatment preference between SBRT and surgical patients.…”

Cost-Effectiveness of Surveillance Scanning Strategies after Curative Treatment of Non–Small-Cell Lung Cancer

“…For this purpose, a life table for the simulated stage I NSCLC population was used, containing statistics on age, sex, and remaining life-years until death due to other causes than cancer, adjusted for smoking. 18 In the simulated patient population, all primary tumors are assumed to be successfully treated, without complications or mortality. However, a proportion of the population ( P micrometa ) has undetected metastases after treatment of their primary tumor.…”

“…A previously developed microsimulation model was extended for the purpose of this cost-effectiveness analysis (CEA). 18 The model consists of 2 components that closely interact: the disease model and the clinical pathway ( Figure 1). The disease model simulates underlying tumor growth to determine recurrence-free survival and the OS for each patient.…”