Efficacy and cost-effectiveness analysis of external beam and stereotactic body radiation therapy in the treatment of spine metastases: a matched-pair analysis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The objective of this study was to compare the palliative efficacy and cost effectiveness of external beam radiation therapy (EBRT) to stereotactic body radiation therapy (SBRT) as primary treatment for bone metastatic disease of the spinal column.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Forty-four patients were matched based on age, primary tumor site, year of treatment, and location of metastasis. Outcomes of interest were pain relief, cost-effectiveness, toxicities, and need for further intervention. Pain relief was rated as excellent, good, fair, or poor, using a radiosurgical pain scale to combine visual analog scale and verbal descriptor ordinal scale scores. Medicare fee schedules were used to compute the charges for both the technical and professional components of care. Patients in the EBRT group were treated using a linear accelerator while patients in the SBRT group were treated with the CyberKnife robotic radiosurgery system. Patients received regular follow-up evaluations by a radiation oncologist and neurosurgeon.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Forty-four patients (22 pairs) were analyzed. At a follow-up of 1 month, there was no statistically significant difference in pain between the 2 groups (p = 0.11). Patients who underwent SBRT had the highest total gross charge; depending on technique, EBRT treatments ranged from 29% to 71% of the SBRT charge. Patients treated using EBRT had more acute toxicities, and more of these patients underwent further intervention at the treated spinal level. There were no late complications attributed to either treatment modality.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>External beam radiation therapy remains an efficacious and cost-effective method of palliation of spine metastases. In this study, patients treated with EBRT had more acute toxicities and were more likely to require additional interventions at the treated sites. Stereotactic body radiation therapy, although more costly, resulted in comparable rates of pain relief and late treatment-related toxicity, and continues to show promise as an emerging modality for selected patients with spine metastases.</jats:p></jats:sec>

Single-session and multisession CyberKnife radiosurgery for spine metastases—University of Pittsburgh and Georgetown University experience

“…Refinement of the combination of a number of these strategies has improved clinical outcome and the quality of life of many patients, although as many as 50% of patients will require further intervention for recurrent pain. 7,14 External-beam radiation therapy remains the mainstay of adjuvant therapy for spinal metastases and offers significant short-term and, in some instances, long-term palliation. Although 30 Gy in 10 fractions is the most common fractionation schedule, multiple fractionation schemes have been reported.…”

Cost-Effectiveness Analysis of Single Fraction of Stereotactic Body Radiation Therapy Compared With Single Fraction of External Beam Radiation Therapy for Palliation of Vertebral Bone Metastases

“…Cohorts were followed up during their remaining lifetimes; the Markov cycle length was 1 month. The Markov model is shown in Figure 1 representing transition probabilities between health states based on medical literatureebased treatment outcome and survival rates (Table 1) (1,(17)(18)(19)(20)(21). For our model calibration, Markov cohort probability analysis was performed for the expected survival rates for both SBRT and EBRT cohorts.…”

A Nationwide Study of Stereotactic Radiosurgery in a Newly Diagnosed Spine Metastasis Population

“…Sahgal et al [1] proposed that SRS is approximately 3-4 times as expensive as CRT. Haley et al [16 ]also compared SRS with CRT, and concluded that SRS is more costly than CRT. In addition, when we consider that SRS is a newly emerging technique and that there may be a need for improved equipment and software, the higher costs in the SRS group were predictable.…”