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Clinical Trial
. 2021 May 13;28(3):1857-1866.
doi: 10.3390/curroncol28030172.

Cost-Effectiveness Analysis of Stereotactic Ablative Body Radiotherapy for the Treatment of Oligometastatic Tumors versus Standard of Care

Adam J N Raymakers  1   2 , David Cameron  1 , Scott Tyldesley  3   4 , Dean A Regier  1   5
Affiliations
Clinical Trial

Cost-Effectiveness Analysis of Stereotactic Ablative Body Radiotherapy for the Treatment of Oligometastatic Tumors versus Standard of Care

Adam J N Raymakers et al. Curr Oncol. .

Abstract

Background: Recent clinical trial results reported that stereotactic radiotherapy (SABR) may improve survival for patients with oligometastatic (OM) cancer. Given that these results come from a phase II trial, there remains considerable uncertainty about this finding, and about the cost-effectiveness of SABR for patients with OM cancer. In this analysis, we estimate the cost-effectiveness of SABR for oligometastatic cancer patients.

Methods: A probabilistic time-dependent Markov model was constructed to simulate treatment of oligometastatic cancer patients over five- and ten-year time horizons. The primary data source was the phase II, Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastases (SABR-COMET )trial and supplemented with data from the literature. We estimated the effect of SABR and the standard of care (SoC) using quality-adjusted life-years (QALYs). Costs were measured from a provincial payer perspective (2018 Canadian dollars).

Results: In the reference case analysis (five-year time horizon), SABR was associated with additional incremental costs of CAD 38,487 and an incremental QALY gain of 0.84. This resulted in an incremental cost-effectiveness ratio (ICER) of CAD 45,726 per QALY gained. Over a ten-year time horizon, the increased uncertainty in the long-term effectiveness of SABR resulted in an ICER of CAD 291,544 per QALY gained. Estimates from the probabilistic analysis indicated that at a willingness-to-pay (WTP) threshold of CAD 50,000 and CAD 100,000 per QALY gained, there is 54% and 78% probability (respectively) that SABR would be cost-effective using the five-year time horizon.

Conclusions: The adoption of SABR therapy requires a considerable upfront capital investment. Our results suggest that the cost-effectiveness of SABR is contingent on the uncertainty in the evidence base. Further clinical trials to confirm the effectiveness of SABR and research into the real-world costs associated with this treatment could reduce the uncertainty around implementation of the technology.

Keywords: SABR; cost-effectiveness analysis; cost-utility analysis; early health technology assessment; economic evaluation; health technology assessment; radiotherapy.

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Conflict of interest statement

We have read and understood Current Oncology’s policy on disclosing conflicts of interest and declare the following interests: D.C. has no potential conflict of interest to declare. A.J.N.R. declares having consulted for the pan-Canadian Oncology Drug Review (pCODR) at the Canadian Agency for Drugs and Technologies in Health. D.A.R. has received funding for conference travel from Illumina and honoraria from Roche. S.T. has received honoraria from Bayer (in relation to radium 223 for prostate cancer), and Janssen (in relation to apalutamide for prostate cancer).

Figures

Figure 1
Figure 1
Conceptual diagram representing the SABR treatment arm and comparator arm (systemic therapy) of the economic model for patients with oligometastatic disease. The model arms differ by the initial treatment received and by subsequent probabilities, but are conceptually the same.
Figure 2
Figure 2
Incremental cost-effectiveness ratio (ICER) scatter plot presenting results of the five-year time horizon, based on 10,000 iterations of the probabilistic analysis. (QALYs = quality-adjusted life-years).
Figure 3
Figure 3
Cost-effectiveness acceptability curve (CEAC) of the ICER using a five-year model time horizon. QALY: quality-adjusted life-year; WTP: willingness-to-pay.
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