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. 2021 Aug:161:74-82.
doi: 10.1016/j.radonc.2021.05.022. Epub 2021 Jun 3.

Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling

Charisma Hehakaya  1 , Jochem R N van der Voort van Zyp  2 , Ben G L Vanneste  3 , Janneke P C Grutters  4 , Diederick E Grobbee  5 , Helena M Verkooijen  6 , Geert W J Frederix  7
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Free article

Early health economic analysis of 1.5 T MRI-guided radiotherapy for localized prostate cancer: Decision analytic modelling

Charisma Hehakaya et al. Radiother Oncol. 2021 Aug.
Free article

Abstract

Background and purpose: 1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Clinical evidence is lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy.

Materials and methods: A state transition model was developed for men with localized prostate cancer. Complication rates such as grade ≥2 urinary, grade ≥2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR-Linac to be cost-effective, while holding other outcomes such as biochemical progression and mortality constant. One-way sensitivity analyses were performed to outline uncertainty outcomes.

Results: At €6460 per patient, no reductions in complications were needed to consider MR-Linac cost-effective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression.

Conclusions: MR-Linac is found to be cost-effective compared to 20 and 39 fractions EBRT at baseline. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs.

Keywords: Early cost-effectiveness; Localized prostate cancer; MR-Linac; MRI-guided radiotherapy.

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Conflict of interest statement

Declaration of interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare no personal conflicts of interest. Several MR-Linac scientific projects at the Division of Imaging and Oncology of University Medical Center Utrecht have been partly funded Elekta AB (Stockholm, Sweden) and Philips Medical Systems (Best, The Netherlands).

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