Cost-effectiveness of modern radiotherapy techniques in locally advanced pancreatic cancer

James D. Murphy, Daniel T. Chang, Jon Abelson, Megan E Daly, Heidi N. Yeung, Lorene M. Nelson, Albert C. Koong

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

Background: Radiotherapy may improve the outcome of patients with pancreatic cancer but at an increased cost. In this study, the authors evaluated the cost-effectiveness of modern radiotherapy techniques in the treatment of locally advanced pancreatic cancer. Methods: A Markov decision-analytic model was constructed to compare the cost-effectiveness of 4 treatment regimens: gemcitabine alone, gemcitabine plus conventional radiotherapy, gemcitabine plus intensity-modulated radiotherapy (IMRT); and gemcitabine with stereotactic body radiotherapy (SBRT). Patients transitioned between the following 5 health states: stable disease, local progression, distant failure, local and distant failure, and death. Health utility tolls were assessed for radiotherapy and chemotherapy treatments and for radiation toxicity. Results: SBRT increased life expectancy by 0.20 quality-adjusted life years (QALY) at an increased cost of $13,700 compared with gemcitabine alone (incremental cost-effectiveness ratio [ICER] = $69,500 per QALY). SBRT was more effective and less costly than conventional radiotherapy and IMRT. An analysis that excluded SBRT demonstrated that conventional radiotherapy had an ICER of $126,800 per QALY compared with gemcitabine alone, and IMRT had an ICER of $1,584,100 per QALY compared with conventional radiotherapy. A probabilistic sensitivity analysis demonstrated that the probability of cost-effectiveness at a willingness to pay of $50,000 per QALY was 78% for gemcitabine alone, 21% for SBRT, 1.4% for conventional radiotherapy, and 0.01% for IMRT. At a willingness to pay of $200,000 per QALY, the probability of cost-effectiveness was 73% for SBRT, 20% for conventional radiotherapy, 7% for gemcitabine alone, and 0.7% for IMRT. Conclusions: The current results indicated that IMRT in locally advanced pancreatic cancer exceeds what society considers cost-effective. In contrast, combining gemcitabine with SBRT increased clinical effectiveness beyond that of gemcitabine alone at a cost potentially acceptable by today's standards.

Original languageEnglish (US)
Pages (from-to)1119-1129
Number of pages11
JournalCancer
Volume118
Issue number4
DOIs
StatePublished - Feb 15 2012
Externally publishedYes

Keywords

  • combined modality therapy
  • cost-benefit analysis
  • pancreatic neoplasms
  • stereotactic body radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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  • Cite this

    Murphy, J. D., Chang, D. T., Abelson, J., Daly, M. E., Yeung, H. N., Nelson, L. M., & Koong, A. C. (2012). Cost-effectiveness of modern radiotherapy techniques in locally advanced pancreatic cancer. Cancer, 118(4), 1119-1129. https://doi.org/10.1002/cncr.26365