Cost Effectiveness Analysis of Radiofrequency Ablation (RFA) Versus Stereotactic Body Radiotherapy (SBRT) for Early Stage Renal Cell Carcinoma (RCC) |
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| Affiliation: | 1. Juravinski Cancer Center, Department of Radiation Oncology, McMaster University, Hamilton, Ontario, Canada;2. Department of Health Economics, McMaster University, Hamilton, Ontario, Canada;3. Sunnybrook Odette Cancer, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada;4. Peter McCallum Cancer Center, Sir Peter MaCallum Department of Oncology, University of Melbourne, Victoria, Australia;5. Juravinski Cancer Center, Department of Surgery, McMaster University, Hamilton, Ontario, Canada;1. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Urology, IRCCS Policlinico San Martino, Genova, Italy;4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;5. Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy;6. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;7. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;9. Departments of Urology, Weill Cornell Medical College, New York, NY;10. Department of Urology, University of Texas Southwestern, Dallas, TX;11. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic;12. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;13. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan;1. Department of Urology and Pediatric Urology, University Hospital of Würzburg, Würzburg, Germany;2. Department of Urology, University Hospital of Tübingen, Germany;3. King Salman Hospital (MOH), Riyadh, Saudi-Arabia;1. Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia;2. Urooncology Unit. Hospital Clinic, Universitat de Barcelona, Barcelona, Spain;1. Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY;2. Department of Radiation Oncology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY;1. Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany;2. Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany;1. Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia PA;2. Wayne State University Department of Urology, Detroit, MI;3. Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia PA |
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| Abstract: | ObjectivesTo conduct a cost-effectiveness analysis of stereotactic body radiotherapy (SBRT) versus radiofrequency ablation (RFA) in the non-surgical management of early stage renal cell carcinoma (RCC) according to Consolidated Health Economic Evaluation Reporting Standards (CHEERS) criteria in the Canadian healthcare system.MethodsA Markov state transition model was constructed for initial local treatment with RFA or SBRT for early stage, kidney confined, medically inoperable RCC in a hypothetical cohort. Incremental cost effectiveness ratios (ICER) were then calculated to compare the two treatments. The analysis was conducted over 5-year time horizon from the perspective of a publicly funded health system in Canada. Secondary analyses were conducted to assess the effect of small versus large size (< 4 cm vs. > 4 cm) RCC on ICERs. Multiple one-way deterministic sensitivity analysis were conducted. Discounting of 1.5% per year was applied.ResultsOver 5 years, SBRT economically dominated RFA with a gain of 4.103 quality-adjusted life years (QALYs) and a cost of $16,097, compared with 3.607 QALYs at a cost of $18,324 for RFA. The ICER was $4490 CAD less per QALY for SBRT in the base case analysis (BCE). In patients with small tumors (T1a), SBRT compared with RFA was more effective and marginally more costly, resulting in an ICER of $2207 CAD per QALY gained, while for larger tumors (T1b), SBRT was less costly and more effective than RFA, resulting in an ICER of -$22904. Sensitivity analysis demonstrated significant variability in the cost-effectiveness of SBRT versus RFA when parameters were varied, with rates of distant metastasis following RFA or SBRT having the greatest implications on ICERs.ConclusionOverall, SBRT used as a primary treatment for RCC shows promising effectiveness at an overall reduction in cost compared with RFA in the Canadian healthcare system. The use of SBRT appears to be cost-effective for larger tumors as well as smaller tumors. The validity of these conclusions are highly sensitive to the accuracy of local and distant progression rates reported in previous studies, and may be adjusted as the available data on SBRT and RFA continues to evolve and mature. |
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| Keywords: | radiofrquency ablation renal cell carcinoma stereotactic body radiotherapy incremental cost-effectiveness |
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