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Konski A
Cost-effectiveness of intensity-modulated radiation therapy
Expert Review of Pharmacoeconomics and Outcomes Research. 2005 ;5(2) :137-140
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Technical advances have given medicine the opportunity to refine current treatment techniques to improve outcomes. Computed tomography, magnetic resonance imaging and high energy linear accelerators are but a few examples of technology translating into clinical practice. Intensity-modulated radiation therapy is a form of 3D conformal radiation that is being increasingly incorporated into the management of patients with prostate cancer. As with any new technology, the cost of intensity-modulated radiation therapy is considerably greater than standard therapy. Economic models can be useful to compare treatments when this comparison cannot be performed in a clinical trial. A Markov Model was used to compare the use of intensity-modulated radiation with 3D conformal radiation therapy in the treatment of a 70 year old man with a good- and intermediate-risk prostate cancer. Cost data for men with Medicare insurance and prostate cancer treated with intensity-modulated radiation therapy and 3D conformal radiation therapy was obtained from the billing department at the Fox Chase Cancer Center (PA, USA). Utilities were collected from men undergoing intensity-modulated radiation therapy and 3D conformal radiation therapy for prostate cancer. Intensity-modulated radiation therapy was found to be cost effective in the treatment of a 70 year old man with prostate cancer with a incremental cost-effectiveness ratio of US$ 16,182 /quality-adjusted life year for men with intermediate-risk prostate cancer and US$ 17,448/ quality-adjusted life year for men with good-risk prostate cancer. Sensitivity analysis found that a longer time horizon of the analysis and younger age at treatment favorably impact the cost-effectiveness ratio. © 2005 Future Drugs Ltd.
14737167 (ISSN) Cited By: 0; Export Date: 25 May 2006; Source: Scopus CODEN: ERPOB; DOI: 10.1586/14737167.5.2.137 Language of Original Document: English Correspondence Address: Konski, A.; Department of Radiation Oncology; Fox Chase Cancer Center; 333 Cottman Ave. Philadelphia, PA 19111, United States; email: andre.konski@fccc.edu References: Young, R., Snyder, B., IMRT (intensity modulated radiation therapy): Progress in technology and reimbursement (2001) Radiol. Manage., 23 (6), pp. 20-26; Zelefsky, M.J., Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer (1998) Int. J. Radiat. Oncol. Biol. Phys., 41 (3), pp. 491-500; Zelefsky, M.J., High-dose intensity modulated radiation therapy for prostate cancer: Early toxicity and biochemical outcome in 772 patients (2002) Int. J. Radiat. Oncol. Biol. Phys., 53 (5), pp. 1111-1116; Fleming, C., A decision analysis of alternative treatment strategies for clinically localized prostate cancer (1993) JAMA, 269 (20), pp. 2650-2658, Prostate Patient Outcomes Research Team; Hanks, G.E., Dose response in prostate cancer with 8-12 years' follow-up (2002) Int. J. Radiat. Oncol. Biol. Phys., 54 (2), pp. 427-435; Chism, D.B., Late morbidity profiles in prostate cancer patients treated to 79-84 Gy by a simple four-field coplanar beam arrangement (2003) Int. J. Radiat. Oncol. Biol. Phys., 55 (1), pp. 71-77; Oefelein, M.G., Agarwal, P.K., Resnick, M.I., Survival of patients with hormone refractory prostate cancer in the prostate specific antigen era (2004) J. Urol., 171 (4), pp. 1525-1528; Scher, H.I., Post-therapy serum prostate-specific antigen level and survival in patients with androgen-independent prostate cancer (1999) J. Natl. Cancer Inst., 91 (3), pp. 244-251; Consensus statement: Guidelines for PSA following radiation therapy (1997) Int. J. Radiat. Oncol. Biol. Phys., 37, pp. 1035-1041, American Society for Therapeutic Radiology and Oncology Consensus Panel; Kuntz, M.C., Modelling in economic evaluation (2001) Economic Evaluation in Health Care, Drummond A (Ed.). Oxford University Press, Oxford, UK; Briggs, A.H., Handling uncertainty in economic evaluation and presenting the results (2001) Economic Evaluation in Health Care, Drummond A (Ed.). Oxford University Press, Oxford, UK; Piper, N.Y., Adenocarcinoma of the prostate: An expensive way to die (2002) Prostate Cancer Prostatic Dis., 5 (2), pp. 164-166; Doubilet, P., Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach (1985) Med. Dec. Making, 5 (2), pp. 157-177; EuroQol - A new facility for the measurement of health-related quality of life (1990) Health Pol., 16, pp. 199-208, The EuroQol Group; Hummel, S., Clinical and cost-effectiveness of new and emerging technologies for early localised prostate cancer: A systematic review (2003) Health Technol. Assess., 7 (33), pp. 1-157.