HIMRT is more cost-efficient than CIMRT for treating prostate cancer, taking into account additional costs owing to late radiation toxicities.
Khinh Ranh Voong, MD, MPH, Lincy S. Lal, PhD, Deborah A. Kuban, MD, Thomas J. Pugh, MD, J. Michael Swint, PhD, Robert R. Trujillo, Joy Godby, Seungtaek Choi, MD, Andrew K. Lee, MD, MPH, Pamela J. Schlembach, MD, Usama Mahmood, MD, Steven J. Frank, MD, Sean E. McGuire, MD, PhD, Karen E. Hoffman, MD, MPH; UT MD Anderson Cancer Center; UT School of Public Health
PURPOSE: Hypofractionated prostate radiation (HIMRT) shortens the treatment course while providing outcomes comparable with conventionally fractionated radiation (CIMRT). To determine the long-term economic value of HIMRT, including the costs of managing radiation toxicities that develop after treatment, a cost minimization analysis compared CIMRT with dose-escalated HIMRT using data from a randomized trial.
PATIENTS AND METHODS: Men 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 wk). 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 2014 national reimbursement rates for services received. Patient-level institutional costs, adjusted to 2014 dollars, verified reimbursements. Sensitivity analysis assessed model uncertainty.
RESULTS: The cost for HIMRT and toxicity management was $22,957, saving $7,000 compared with CIMRT ($30,241). CIMRT was the common factor among the five 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 or urinary toxicity. However, toxicity management reached up to 26% of total costs 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 savings).
CONCLUSION: HIMRT is more cost-efficient than CIMRT for treating prostate cancer, taking into account additional costs owing to late radiation toxicities.
Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org