Long-term economic value of hypofractionated prostate radiation: Secondary analysis of a randomized trial

Abstract

PurposeModerately hypofractionated intensity modulated radiation therapy (HIMRT) for prostate cancer shortens the treatment course while providing outcomes comparable with those of conventional intensity modulated radiation therapy (CIMRT). To determine the long-term economic value of HIMRT, including the costs of managing long-term radiation toxicities, a cost minimization analysis compared CIMRT with dose-escalated HIMRT using patient-level data from a randomized trial.Methods and materialsMen with localized prostate cancer were randomized to CIMRT (75.6 Gy in 42 fractions over 8.4 weeks) or HIMRT (72 Gy in 30 fractions over 6 weeks). A decision tree modeled trial probabilities of maximum late bowel and urinary toxicities using patient-level data with a median follow-up of 6 years. Costs were estimated from the healthcare perspective using the 2014 national reimbursement rates for services received. Patient-level institutional costs, adjusted to 2014 dollars, verified reimbursements. A sensitivity analysis assessed model uncertainty.ResultsThe cost for HIMRT and toxicity management was $22,957, saving $7,000 compared with CIMRT ($30,241). CIMRT was the common factor among the 5 most influential scenarios that contributed to total costs. Toxicity represented a small part (<10%) of the average total cost for patients with either grade 2-3 bowel toxicity or grade 2-3 urinary toxicity. However, toxicity management reached up to 26% of the total cost for patients with both high-grade bowel and urinary toxicities. There was no threshold at which CIMRT became the less costly regimen. Institutional costs confirmed the economic value of HIMRT ($6,000 in savings).ConclusionsHIMRT is more cost-efficient than CIMRT for treating prostate cancer, even when taking into account the costs related to late radiation toxicities. HIMRT enhances the value of prostate radiation when compared with CIMRT.

Cost‐containment in hypofractionated radiation therapy: a literature review

“…Prostate cancer accounts for the longest course of radiation therapy by comparison with other anatomical sites, due to the radioresistant nature of prostatic tissue. International standards suggest that prostate radiation therapy is given as 75.6–81.0 Gy in 1.8–2.0 Gy per fraction over 7–9 weeks . In Australia, typical doses are either 74 Gy (in 37 fractions) or 78 Gy (in 39 fractions) in the setting of post‐prostatectomy or intact prostate respectively.…”

“…However, on cost alone, symptom management represents a small part (<10%) of the average total cost for patients who develop grade 2/3 bowel or urinary toxicity . In contrast, additional studies have demonstrated that hypofractionation is effective in the management of prostate cancer, with attributed health gains …”

“…International standards suggest that prostate radiation therapy is given as 75.6-81.0 Gy in 1.8-2.0 Gy per fraction over 7-9 weeks. 12,14 In Australia, typical doses are either 74 Gy (in 37 fractions) or 78 Gy (in 39 fractions) in the setting of postprostatectomy or intact prostate respectively. In either case, the treatment is rather cumbersome and very expensive.…”

“…US data suggests that a typical course of conventional prostate radiation therapy can cost in the vicinity of $30,241-$37,125 accounting for PSA testing, imaging, symptom management and consultation fees. 12,14 In contrast, a moderate hypofractionation schedule of 30 fractions could see a saving of approximately $7000 per patient, with the course cost weighing in at $22,957. 14 The Australian Medicare Benefits Schedule (MBS) provides a clear framework for the billing of all radiation therapy procedures, including CT/simulation, dosimetry, image verification and daily treatment provision.…”

“…12,14 In contrast, a moderate hypofractionation schedule of 30 fractions could see a saving of approximately $7000 per patient, with the course cost weighing in at $22,957. 14 The Australian Medicare Benefits Schedule (MBS) provides a clear framework for the billing of all radiation therapy procedures, including CT/simulation, dosimetry, image verification and daily treatment provision. MBS item codes vary with the level of complexity of treatment and planning processes.…”