Cost Effectiveness of External Beam Radiation Therapy versus Percutaneous Image-Guided Cryoablation for Palliation of Uncomplicated Bone Metastases |
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| Institution: | 1. Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California;2. Department of Radiology, University of California Los Angeles, Los Angeles, California;3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York;1. Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;2. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York;1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905;2. Department of Anesthesia, Mayo Clinic, 200 First Street SW, Rochester, MN 55905;3. Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905;1. Department of Radiology, Stanford University School of Medicine, Stanford, California;2. Hamad Medical Corporation, Doha, Qatar;3. Veterans Affairs Palo Alto Health Care System, Palo Alto, California;1. Duke University School of Medicine, Durham, North Carolina;2. Division of Interventional Radiology, Duke Health, DUMC Box 3808, Durham, NC, 27710;3. Department of Radiology, Duke Health, DUMC Box 3808, Durham, NC, 27710 |
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| Abstract: | PurposeTo evaluate the cost effectiveness of incorporating cryoablation in the treatment regimens for uncomplicated bone metastases using radiation therapy (RT) in single-fraction RT (SFRT) or multiple-fraction RT (MFRT) regimens.Materials and MethodsA Markov model was constructed using 1-month cycles over a lifetime horizon to compare the cost effectiveness of multiple strategies, including RT followed by RT (RT-RT) for recurrent pain, RT followed by cryoablation (RT-ablation), and cryoablation followed by RT (ablation-RT). RT-RT consisted of 8 Gy in 1 fraction/8 Gy in 1 fraction (SFRT-SFRT) and 30 Gy in 10 fractions/20 Gy in 5 fractions (MFRT-MFRT). Probabilities and utilities were extracted from a search of the medical literature. Costs were calculated from a payer perspective using 2017 Medicare reimbursement in an outpatient setting. Incremental cost effectiveness ratios (ICERs) were calculated using strategies evaluated for willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY). To account for model uncertainty, one-way and probabilistic sensitivity analyses were performed.ResultsIn the base case analysis, SFRT-ablation was cost effective relative to SFRT-SFRT at $96,387/QALY. MFRT-ablation was cost effective relative to MFRT-MFRT at $85,576/QALY. Ablation-SFRT and ablation-MFRT were not cost effective with ICERs >$100,000/QALY. In one-way sensitivity analyses, results were highly sensitive to variation in multiple model parameters, including median survival (base: 9 months), with SFRT-SFRT favored at median survival ≤8.7 months. Probabilistic sensitivity analysis examining SFRT-based regimens showed that SFRT-ablation was preferred in 36.9% of simulations at WTP of $100,000/QALY.ConclusionsCryoablation is a potentially cost-effective alternative to reirradiation with RT for recurrent of pain following RT; however, no strategy incorporating initial cryoablation was cost effective. |
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| Keywords: | ICER"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"incremental cost effectiveness ratio MFRT"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"multiple fraction radiation therapy QALY"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"quality-adjusted life year RT"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"radiation therapy SFRT"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"single fraction radiation therapy WTP"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"willingness-to-pay |
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