Abstract | PURPOSE: To evaluate the cost-effectiveness and outcomes of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy compared with intensity-modulated radiation therapy (IMRT) in patients with low/intermediate risk of prostate cancer. METHODS AND MATERIALS: One thousand three hundred twenty-eight patients with low or intermediate risk of prostate cancer were treated with LDR (n=207), HDR with four fractions (n=252), or IMRT (n=869) between January 1992 and December 2008. LDR patients were treated with palladium seeds to a median dose of 120 Gy, whereas HDR patients were treated to a median dose 38.0 Gy (four fractions). IMRT patients received 42-44 fractions with a median dose of 75.6 Gy. Clinical outcomes were compared, including biochemical failure, cause-specific survival, and overall survival. RESULTS: Overall, no differences in 5-year biochemical control (BC) or cause-specific survival were noted among treatment modalities. The calculated reimbursement for LDR brachytherapy, HDR brachytherapy with four fractions, and IMRT was $9,938; $17,514; and $29,356, respectively. HDR and LDR brachytherapy were statistically less costly to Medicare and the institution than IMRT (p<0.001), and LDR brachytherapy was less costly than HDR brachytherapy (p=0.01 and p<0.001). Incremental cost-effectiveness ratios for cost to Medicare for BC with IMRT were $4045 and $2754 per percent of BC for LDR and HDR brachytherapy, respectively. Incremental cost-effectiveness ratio using institutional cost comparing IMRT with LDR and HDR brachytherapy was $4962 and $4824 per 1% improvement in BC. CONCLUSIONS: In this study of patients with low and intermediate risk of prostate cancer, comparable outcomes at 5 years were noted between modalities with increased costs associated with IMRT.
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Authors | Chirag Shah, Thomas B Lanni Jr, Mihai I Ghilezan, Gary S Gustafson, Kimberly S Marvin, Hong Ye, Frank A Vicini, Alvaro A Martinez |
Journal | Brachytherapy
(Brachytherapy)
2012 Nov-Dec
Vol. 11
Issue 6
Pg. 441-5
ISSN: 1873-1449 [Electronic] United States |
PMID | 22728157
(Publication Type: Comparative Study, Journal Article)
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Copyright | Copyright © 2012 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved. |
Topics |
- Brachytherapy
(economics, mortality)
- Cost-Benefit Analysis
- Health Care Costs
(statistics & numerical data)
- Hospitalization
(economics, statistics & numerical data)
- Humans
- Male
- Michigan
(epidemiology)
- Prevalence
- Prostatic Neoplasms
(economics, mortality, radiotherapy)
- Survival Analysis
- Survival Rate
- Treatment Outcome
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