Toxicity and cost-effectiveness analysis of intensity modulated radiation therapy versus 3-dimensional conformal radiation therapy for postoperative treatment of gynecologic cancers

• Published in: Gynecologic oncology 2015-03, Vol.136 (3), p.521-528
• Main Authors: Chen, L. Andy, Kim, Jaewhan, Boucher, Kenneth, Terakedis, Breanne, Williams, Britney, Nickman, Nancy A, Gaffney, David K
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cost-Benefit Analysis; Databases, Factual; Decision Support Techniques; Endometrial neoplasms; Female; Health care economics; Hematology, Oncology and Palliative Medicine; Hospital Costs - statistics & numerical data; Humans; Hysterectomy; Middle Aged; Obstetrics and Gynecology; Postoperative Period; Quality-Adjusted Life Years; Radiotherapy, Adjuvant; Radiotherapy, conformal; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - economics; Radiotherapy, Conformal - methods; Radiotherapy, intensity-modulated; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - economics; Radiotherapy, Intensity-Modulated - methods; Registries; Retrospective Studies; Survival Analysis; Treatment Outcome; Utah; Uterine cervical neoplasms; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - radiotherapy; Uterine Cervical Neoplasms - surgery; Uterine Neoplasms - economics; Uterine Neoplasms - mortality; Uterine Neoplasms - radiotherapy; Uterine Neoplasms - surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2014.12.039

Abstract Objective To evaluate toxicity and cost-effectiveness of intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT) in the postoperative treatment of uterine and cervical cancer. Methods Between 2000 and 2012, eighty patients at our institution received post-hysterectomy 3DCRT (46) or IMRT (34) for uterine or cervical cancer. Baseline characteristics, outcome, and ≥ CTCAE grade 2 toxicities were compared between the two groups. Predictors of toxicity-free survival were identified. A decision analysis model was designed to capture individual health states at 1, 2, and 3 years after treatment. Micro-costing technique and estimated quality-adjusted life years (QALYs) were used to calculate incremental cost-effectiveness ratio (ICER). Results Utilization of IMRT increased from 25% (2005–2007) to 75% (2008–2012). Recurrence-free and overall survival rates were not different between the two groups. Toxicity rates were reduced with IMRT versus 3DCRT (HR 0.42, p = 0.04). Women who received IMRT had numerically lower rates of late gastrointestinal and genitourinary toxicity and significantly lower rates of late overall toxicity at 3 years (16% vs. 45%, p = 0.04). On univariate analysis, IMRT was associated with decreased late toxicity (HR 0.43, p = 0.04). Treatment costs were higher and toxicity costs were lower with IMRT. IMRT had an ICER of $235,233 (year 1), $114,270 (year 2), and $75,555 (year 3) per QALY gained. Conclusion IMRT is associated with reduced late overall toxicity compared to 3DCRT without compromising clinical outcome. IMRT is not cost-effective during the early chronic toxicity phase, but it becomes more cost-effective over time.