CyberKnife for prostate cancer: Is it cost-effective?

Abstract

87 Background: The study assessed the cost-effectiveness of CyberKnife (CK) compared to surgery and radiation therapy for the treatment of prostate cancer (PC) from a third-party and societal perspective. Methods: For patients > 65 yrs with localized PC, a Markov model compared treatment with CK, intensity modulated radiation therapy (IMRT), surgery or proton therapy (PT). Following treatment, patients were at risk of long-term toxicity: genitourinary (GU); gastrointestinal (GI); and sexual dysfunction (SD). Long-term toxicity was defined as adverse events >grade 2 on Radiation Therapy Oncology Group scale occurring at least 12 months following treatment. Markov states included all possible combinations of GI, GU, and SD long-term toxicities, no toxicity, and death. During each year patients remained in the same Markov state or died. Costs and utilities were assigned using published sources. Toxicity probabilities were derived using meta-analytical techniques to pool results from multiple studies. It was assumed that long-term disease control would not differ across treatments. The model projected expected lifetime costs and quality adjusted life years (QALYs) for each treatment and incremental cost-effectiveness of CK vs comparators as cost per QALY gained. Costs from societal perspective included lost productivity. Extensive sensitivity analyses were conducted. Results: Surgery was the least expensive treatment option followed by CK. CK patients had higher expected QALYs (8.11) than other treatment options (7.72- 8.06). From a payer perspective, total lifetime costs were $25,904, $22,295, $38,915, and $58,100 for CK, surgery, IMRT and PT, respectively. Incremental cost per QALY gained for CK versus Surgery was $9,200/QALY. Compared to IMRT and PT, CK was less costly and resulted in higher QALYs (dominance). At a threshold of $50,000/QALY, CK was cost effective in 86%, 79%, and 91% of simulations compared to surgery, IMRT, and PT, respectively. From a societal perspective, CK costs $4,200/QALY compared to surgery and remained dominant vs IMRT and PT. Results were most sensitive to costs of surgery and CK. Conclusions: Initial CK costs are higher than surgery, but CK patients have better quality of life. CK patients have lower lifetime costs and higher QALYs than IMRT and PT patients. [Table: see text]

Hypofractionated stereotactic body radiotherapy in low‐risk prostate adenocarcinoma

“…With most radiation oncologists using IMRT in the treatment of low‐risk prostate cancer, costs for this relatively indolent disease have increased. A recent American Society of Clinical Oncology abstract using Markov modeling suggests that the total life‐time cost of using the CyberKnife is significantly lower than that of IMRT ($25,904 vs $38,915) 5. That model also projects higher quality‐adjusted life‐years for CyberKnife compared with IMRT.…”

“…In addition to the possibility of decreased recurrence risk, hypofractionation, because of the larger doses delivered per individual treatment, allows for the deposition of dose biologically equivalent to the standard, multiweek regimens over a shorter period of time; for elderly patients with prostate cancer who have difficulties traveling, this has obvious quality‐of‐life (QOL) benefits. Finally, truncating treatment time may carry with it cost benefits compared with now widely adopted, longer course, intensity‐modulated radiation therapy (IMRT) regimens 5…”

“…Finally, truncating treatment time may carry with it cost benefits compared with now widely adopted, longer course, intensity-modulated radiation therapy (IMRT) regimens. 5 The studied hypofractionation regimens can be divided into 2 groups: 1) moderate hypofractionation (eg, 60 Gy in 20 fractions) and 2) extreme hypofractionation (eg, 36.25 Gy in 5 fractions). Several randomized controlled trials (RCTs) that compared standard fractionation with moderate hypofractionation have been published, and all of those trials demonstrated a significant improvement in biochemical recurrence-free survival (bRFS) with equivalent toxicities.…”

Systematic review of hypofractionated radiation therapy for prostate cancer

“…Calculations models have shown that wage costs outweigh the cost of machines due to the labor-intensive nature of RT planning and delivery. 13-16 Moreover, although treatment planning complexity is increasing with evolving technology, the planning is only done at the beginning of therapy while cost builds with the delivery of each fraction. 17 Kesteloot et al 18 estimated that staffing RT facilities accounts for 50% of their cost.…”

A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer

“…The significant reduction in treatment course afforded by SBRT results in overall savings. The mean cost of conventional intensity-modulated RT (IMRT), $29,356,64 is higher than the estimated cost of robotic arm SBRT, between $19,275 and $24,873 55,58,65,66. Parthan et al compared the cost-effectiveness of IMRT with SBRT and proton-beam therapy using the Markov model, assuming equal long-term efficacy.…”