Cost-Effectiveness of Subsequent Whole-Brain Radiotherapy or Hippocampal-Avoidant Whole-Brain Radiotherapy Versus Stereotactic Radiosurgery or Surgery Alone for Treatment of Melanoma Brain Metastases
- 11 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Applied Health Economics and Health Policy
- Vol. 18 (5), 679-687
- https://doi.org/10.1007/s40258-020-00560-1
Abstract
Background A randomized phase III trial comparing whole-brain radiotherapy (WBRT) to observation following definitive local treatment of intracranial melanoma metastases with neurosurgery and/or stereotactic surgery (SRS) is underway. Objective We sought to assess the pre-trial cost-effectiveness of WBRT, hippocampal-avoidant WBRT (HA-WBRT), and observation (SRS or surgery alone) for this population to guide trial data collection efforts and reduce decision uncertainty. Methods A time-dependent Markov model followed patients treated with neurosurgery or SRS who received subsequent WBRT, HA-WBRT or observation over a 5-year time horizon. Model inputs were sourced from published literature and results tested for robustness using probabilistic sensitivity analysis. Value of information (VOI) analysis was undertaken to guide data collection for the randomized trial. Results Over 5 years, the WBRT strategy produced 1.74 QALYs (2.38 life-years) at a mean cost of $40,128 (costs in 2017 Australian dollars); HA-WBRT produced 1.88 QALYs (2.38 life-years) and cost $42,977; and SRS/surgery alone produced 1.65 QALYs (2.13 life-years) at a cost of $46,281. Probabilistic sensitivity analysis showed HA-WBRT was the preferred strategy in 77% of simulations. Cost-effectiveness results were most sensitive to utilities of the controlled-disease health state in the WBRT group, and costs of HA-WBRT. The EVPI for a randomized trial was estimated at $6,888 per person. Conclusions HA-WBRT may be cost-effective for the treatment of melanoma brain metastases. The results predicted in our model can be validated with prospective trial data when available.Keywords
This publication has 22 references indexed in Scilit:
- Health care use and costs at the end of life: a comparison of elderly Australian decedents with and without a cancer historyBMC Palliative Care, 2017
- Debate: adjuvant whole brain radiotherapy or not? More data is the wiser choiceBMC Cancer, 2016
- Should patients with melanoma brain metastases receive adjuvant whole-brain radiotherapy?The Lancet Oncology, 2015
- Preservation of Memory With Conformal Avoidance of the Hippocampal Neural Stem-Cell Compartment During Whole-Brain Radiotherapy for Brain Metastases (RTOG 0933): A Phase II Multi-Institutional TrialJournal of Clinical Oncology, 2014
- Whole brain radiotherapy after local treatment of brain metastases in melanoma patients - a randomised phase III trialBMC Cancer, 2011
- Adjuvant Whole-Brain Radiotherapy Versus Observation After Radiosurgery or Surgical Resection of One to Three Cerebral Metastases: Results of the EORTC 22952-26001 StudyJournal of Clinical Oncology, 2011
- Prognostic factors for survival in melanoma patients with brain metastasesCancer, 2010
- Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trialThe Lancet Oncology, 2009
- Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trialThe Lancet, 2004
- Postoperative Radiotherapy in the Treatment of Single Metastases to the BrainJAMA, 1998