Early economic modeling of magnetic resonance image-guided high intensity focused ultrasound compared to radiotherapy for pain palliation of bone metastases

Abstract

IntroductionMagnetic Resonance Image-guided High Intensity Focused Ultrasound (MR-HIFU) is a non-invasive treatment option for palliative patients with painful bone metastases. Early evidence suggests that MR-HIFU is associated with similar overall treatment response, but more rapid pain palliation compared to external beam radiotherapy (EBRT). This modelling study aimed to assess the cost-effectiveness of MR-HIFU as an alternative treatment option for painful bone metastases from the perspective of the German Statutory Health Insurance (SHI).Materials and methodsA microsimulation model with lifelong time horizon and one-month cycle length was developed. To calculate the incremental cost-effectiveness ratio (ICER), strategy A (MR-HIFU as first-line treatment or as retreatment option in case of persistent pain or only partial pain relief after EBRT) was compared to strategy B (EBRT alone) for patients with bone metastases due to breast, prostate, or lung cancer. Input parameters used for the model were extracted from the literature. Results were expressed as EUR per quality-adjusted life years (QALYs) and EUR per pain response (i.e., months spent with complete or partial pain response). Deterministic and probabilistic sensitivity analyses (PSA) were performed to test the robustness of results, and a value of information analysis was conducted.ResultsCompared to strategy B, strategy A resulted in additional costs (EUR 399) and benefits (0.02 QALYs and 0.95 months with pain response). In the base case, the resulting ICERs (strategy A vs. strategy B) are EUR 19,845/QALY and EUR 421 per pain response. Offering all patients MR-HIFU as first-line treatment would increase the ICER by 50% (31,048 EUR/QALY). PSA showed that at a (hypothetical) willingness to pay of EUR 20,000/QALY, the probability of MR-HIFU being cost-effective was 52%. The expected value of perfect information (EVPI) for the benefit population in Germany is approximately EUR 190 Mio.ConclusionAlthough there is considerable uncertainty, the results demonstrate that introducing MR-HIFU as a treatment alternative for painful bone metastases might be cost-effective for the German SHI. The high EVPI indicate that further studies to reduce uncertainty would be worthwhile.

High Intensity Focused Ultrasound for Treatment of Bone Malignancies—20 Years of History

“…An early economic modeling study demonstrated that adding MR-HIFU to RT regimes, independent of the sequence of treatment, resulted in better quality-adjusted life years (QALYs) and more durable pain response, compared with RT alone for pain palliation of bone metastasis. Furthermore, MR-HIFU has a 52% probability of being cost-effective compared with RT, according to probabilistic sensitivity analysis in the treatment of bone metastasis [53]. On the other hand, the shortcomings of HIFU include its long procedural time and the fact that it is limited to lesions that have unobstructed acoustic pathways, i.e., lesions that can be accessed and treated by HIFU and can be reached by a transducer.…”

The Applications of High-Intensity Focused Ultrasound (HIFU) Ablative Therapy in the Treatment of Primary Breast Cancer: A Systematic Review

“…For low-and intermediate-risk prostate cancer, active surveillance is more cost-effective than HIFU, but with high uncertainty [26]. In contrast, the use of HIFU as an alternative treatment for painful bone metastases might be cost-effective despite the considerable uncertainty [27]. Further exploration is needed regarding the cost-effectiveness of HIFU therapy for the treatment of breast cancer.…”

The Role of Ultrasound in Cancer and Cancer-Related Pain—A Bibliometric Analysis and Future Perspectives

“…At the Central nervous system (CNS) level, clinical trials on HIFU-mediated medial or central lateral thalamotomies for neuropathic pain management were successfully conducted with long-term efficacies. Neuromodulation at the Peripheral nervous system (PNS) has given great success for the US-based management of cancer-induced pain [ 8 , 10 ].…”