Cost‐effectiveness analysis of intensity‐modulated radiation therapy with normal and hypofractionated schemes for the treatment of localised prostate cancer

The aim of our analysis was to compare the cost‐effectiveness of high‐dose intensity‐modulated radiation therapy (IMRT) and hypofractionated intensity‐modulated radiation therapy (HF‐IMRT) versus conventional dose three‐dimensional radiation therapy (3DCRT) for the treatment of localised prostate cancer. A Markov model was constructed to calculate the incremental quality‐adjusted life years and costs. Transition probabilities, adverse events and utilities were derived from relevant systematic reviews. Microcosting in a large university hospital was applied to calculate cost vectors. The expected mean lifetime cost of patients undergoing 3DCRT, IMRT and HF‐IMRT were 7,160 euros, 6,831 euros and 6,019 euros respectively. The expected quality‐adjusted life years (QALYs) were 5.753 for 3DCRT, 5.956 for IMRT and 5.957 for HF‐IMRT. Compared to 3DCRT, both IMRT and HF‐IMRT resulted in more health gains at a lower cost. It can be concluded that high‐dose IMRT is not only cost‐effective compared to the conventional dose 3DCRT but, when used with a hypofractionation scheme, it has great cost‐saving potential for the public payer and may improve access to radiation therapy for patients.