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

Charisma Hehakaya; Jochem R N van der Voort van Zyp; Ben G L Vanneste; Janneke P C Grutters; Diederick E Grobbee; Helena M Verkooijen; Geert W J Frederix

doi:10.1016/j.radonc.2021.05.022

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

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

Authors

Charisma Hehakaya¹, Jochem R N van der Voort van Zyp², Ben G L Vanneste³, Janneke P C Grutters⁴, Diederick E Grobbee⁵, Helena M Verkooijen⁶, Geert W J Frederix⁷

Affiliations

¹ Division of Imaging & Oncology, University Medical Center Utrecht, The Netherlands; Julius Clinical, Zeist, The Netherlands. Electronic address: c.hehakaya@umcutrecht.nl.
² Division of Imaging & Oncology, University Medical Center Utrecht, The Netherlands.
³ Department of Radiation Oncology, MAASTRO Clinic, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
⁴ Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.
⁵ Julius Clinical, Zeist, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands; Utrecht University, The Netherlands.
⁶ Division of Imaging & Oncology, University Medical Center Utrecht, The Netherlands; Utrecht University, The Netherlands.
⁷ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

PMID: 34089754
DOI: 10.1016/j.radonc.2021.05.022

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brachytherapy*
Dose Fractionation, Radiation
Humans
Magnetic Resonance Imaging
Male
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / radiotherapy