Few studies were found that examine the cost effectiveness of radiotherapy for breast, cervical, colorectal, head and neck and prostate cancer, and only two analyses were conducted in the UK. |
Additional, high-quality evidence is required to inform decision making on the effectiveness and cost-effectiveness of radiotherapy in cancer. |
Many recent publications identified in the review did not satisfy essential methods requirements. Forthcoming economic evaluations of radiotherapy in cancer should adhere to such requirements to better inform decision makers. |
1 Introduction
2 Methods
3 Results
3.1 Results of the Review
References | Setting | Population | Intervention | Comparator | Study design | Main findings |
---|---|---|---|---|---|---|
Breast cancer
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Alvegard et al., 2005 [22] | Sweden | Stage I–II BC | Postoperative RT | No RT | Model (not explicit) | Post-operative RT is cost effective when used as adjunction to no medical adjuvant tx and in high-risk pts |
Dunscombe et al., 2000 [20] | Canada | Premenopausal node-positive BC | Adjuvant loco regional RT (RT plus surgery and chemotherapy) | No RT | Spreadsheet-based activity-costing model | Adjuvant RT is a cost-effective tx |
Hayman et al., 1998 [13] | USA | Stage I–II BC | Adjuvant RT | No RT | Markov model | RT is cost effective following conservative surgery |
Hayman et al., 2000 [14] | USA | Stage I–II BC | Adding an electron-beam boost to tangential RT | RT without tangential boost | Markov model | Boost is not cost effective using a threshold of $50,000 per QALY |
Lee et al., 2002 [15] | USA | High-risk premenopausal node-positive BC | PMRT | No PMRT | Markov model | PMRT is cost-effective; results of model were robust |
Lievens et al., 2005 [24] | Belgium | Stage I–III BC | Post-operative RT to the internal mammary and medial supraclavicular lymph node region | No RT | Markov model | RT was cost effective when evaluated over a long time period in tumours with a slow natural history and systemic tx for relapse |
Liljegren et al., 1997 [23] | Sweden | Unifocal stage I BC post sector resection and axillary dissection | Post-operative RT | No RT | Model (decision tree)-based | Cost of RT is high; results show the importance of identifying risk factors for local recurrence |
Lundkvist et al., 2005 [11] | Sweden | BC (not specified) | Proton RT | Conventional RT | Markov model | Likely that proton RT is more appropriate for individuals with higher than norm risk of CVD |
Marks et al., 1999 [16] | USA | Local regional relapse node-positive BC | RT | No RT | EE using data from several clinical studies | Cost per local regional relapse prevented decreases as the number of positive axillary nodes increases |
Patrice et al., 2007 [17] | USA | Early-stage BC | RT plus tamoxifen | Tamoxifen alone | Markov model | RT post conservative surgery was cost effective in older women |
Prescott et al., 2007 [12] | UK | Minimum-risk (elderly women post breast-conserving surgery) | Whole breast RT | No RT | Markov model | While RT was well tolerated with no impairment on overall QoL at 3 years, the no RT intervention was cost effective |
Samant et al., 2001 [21] | Canada | High-risk (postmenopausal) node-positive BC (post mastectomy) | Loco regional RT | No RT | Update of Dunscombe et al., 2000 [21] | RT appears cost effective, but further analyses needed |
Sher et al., 2009 [18] | USA | Early-stage estrogen-receptor positive BC | EB-PBI; MS-PBI | WBRT | Markov model | EB-PBI is cost effective vs. WBRT, but MS-PBI is not and is unlikely to be cost effective unless the QoL after MS-PBI is superior |
Suh et al., 2005 [19] | USA | Ductal carcinoma in situ | RT | No RT | Markov model | Addition of RT following BCS for pts with ductal carcinoma in situ should not be withheld because of concerns regarding its cost effectiveness |
Colorectal cancer
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Dahlberg et al., 2002 [26] | Sweden | Resectable rectal cancer | Preoperative RT followed by surgery within the next week | Surgery without RT | EE alongside clinical trial | Preoperative RT was cost effective even using their most pessimistic assumptions |
van den Brink et al., 2004 [25] | The Netherlands | Resectable rectal cancer | Preoperative RT with TME | TME without preoperative RT | Model-based TME study | Preoperative RT was both effective and cost effective |
Prostate cancer
| ||||||
Basu and Meltzer, 2005 [31] | USA | Early PC | RT | Surgery (not specified), WW | Model (NS) | WW was the most cost-effective option given a threshold of $50,000 per QALY |
Hummel et al., 2003 [28] | UK | Early localised (TNM stages 1 and 2) PC | Traditional RT | WW, RP, brachytherapy, 3D-CRT, cryotherapy | Markov model | Brachytherapy and 3D-CRT appear the most cost-effective options but high variability was found |
Konski and Watkins-Bruner, 2004 [32] | USA | Hormone-refractory PC with bone metastases | SFX, MFX | Pain medication only, chemotherapy (mitoxantrone or prednisone) | Markov model | SFX was the most cost-effective option for palliative tx |
Konski et al., 2005 (RTOG) [34] | USA | Treatment of locally advanced with clinical stage T2b, T2c, T3, T4 PC without distant metastasis | RT plus hormone therapy | RT | Markov model | Adding hormone to RT provided good value for money |
Konski and Konski, 2005 [33] | USA | Clinically localised PC | I-RT | 3D-CRT | Markov model | RT generally cost effective, although it could be less good value for money for old pts and over a short-term time horizon |
Konski et al., 2006 [35] | USA | PC eligible for surgery | I-RT | 3D | Markov model | I-RT could be considered cost effective at the upper limit of acceptability |
Konski et al., 2007 [29] | USA | Intermediate-risk PC | I-RT | PPT | Markov model | PPT is not cost effective in most pts |
Lundkvist et al., 2005 [11] | Sweden | Unspecified PC | Proton therapy | Conventional RT | Markov model | Proton therapy appears a cost-effective option but high variation around mean values was found |
Neymark et al., 2002 [27] | France | PC candidate for surgery | Hormonal therapy plus radiotherapy (COMB) | Conventional RT | EE with data from a clinical trial | COMB was dominant when mean survival time was estimated by a restricted means analysis |
Samant et al., 2003 [30] | Canada | Locally advanced PC | Adjuvant goserelin in addition to RT | RT | EE with data from a clinical trial | Long-term adjuvant goserelin provided good value for money |
Head and neck cancer
| ||||||
Higgins, 2011 [37] | Canada | Early glottis (T1 or T2) cancer | TOL | XRT | Decision tree model- based EE | TOL is dominant over XRT for this group of pts with early cancer |
Konski and Watkins-Bruner, 2004 [32] | USA | Locally advanced HNSCC | AFXC, AHFXS, HFX | Standard fractionated RT | Markov model | HFX and AFXC appear the most cost-effective options |
Lundkvist et al., 2005 [11] | Sweden | H&N (unspecified) | Proton therapy | Conventional RT | Markov model | Proton therapy was the cost-effective option |