Cost-effectiveness of hypofractionated versus conventional fractionated radiotherapy for the treatment of men with early glottic cancer: a study in the Brazilian public and private health system

• Published in: BMC health services research 2023-06, Vol.23 (1), p.592-592, Article 592
• Main Authors: Lourenção, Marina, Arruda, Gustavo Viani, Rocha, Lucas Penna, Galendi, Julia Simões Corrêa, de Oliveira, Jorge Caldeira, Jacinto, Alexandre Arthur
• Format: Article
• Language: English
• Subjects: Care and treatment; Comparative analysis; Conventional fractionation; Cost analysis; Cost-effectiveness; Demographic aspects; Diagnosis; Disease; Disease control; Early glottic cancer; Economic aspects; Fractionation; Glottis; Health aspects; Health care policy; Health services; Hypofractionation; Laryngeal cancer; Larynx; Markov chains; Medical care, Cost of; Metastasis; Methods; Patients; Private sector; Public health; Public sector; Radiation therapy; Radiotherapy; Schedules; Sensitivity analysis; Tumors
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-023-09397-5

This study aims to evaluate whether hypofractionated radiotherapy (HYPOFRT) is a cost-effective strategy than conventional fractionated radiotherapy (CFRT) for early-stage glottic cancer (ESGC) in the Brazilian public and private health systems. Adopting the perspective of the Brazilian public and private health system as the payer, a Markov model with a lifetime horizon was built to delineate the health states for a cohort of 65-year-old men after with ESGC treated with either HYPOFRT or CFRT. Probabilities of controlled disease, local failure, distant metastasis, and death and utilities scores were extracted from randomized clinical trials. Costs were based on the public and private health system reimbursement values. In the base case scenario, for both the public and private health systems, HYPOFRT dominated CFRT, being more effective and less costly, with a negative ICER of R$264.32 per quality-adjusted life-year (QALY) (public health system) and a negative ICER of R$2870.69/ QALY (private health system). The ICER was most sensitive to the probability of local failure, controlled disease, and salvage treatment costs. For the probabilistic sensitivity analysis, the cost-effectiveness acceptability curve indicates that there is a probability of 99.99% of HYPOFRT being cost-effective considering a willingness-to-pay threshold of R$2,000 ($905.39) per QALY (public sector) and willingness-to-pay threshold of R$16,000 ($7243.10) per QALY (private sector). The results were robust in deterministic and probabilistic sensitivity analyses. Considering a threshold of R$ 40,000 per QALY, HYPOFRT was cost-effective compared to CFRT for ESGC in the Brazilian public health system. The Net Monetary Benefit (NMB) is approximately 2,4 times (public health system) and 5,2 (private health system) higher for HYPOFRT than CFRT, which could open the opportunity of incorporating new technologies.