The use of stereotactic body radiation therapy (SBRT) rather than intensity-modulated radiation therapy (IMRT) for low- to intermediate-risk prostate cancer could produce a win-win combination and curb ballooning prostate cancer treatment costs while also trimming individual indirect costs to patients, according to a study published online in the May issue of the American Journal of Managed Care.
Prostate cancer ranks as the fifth most costly cancer, and accounted for more than $12 billion in treatment costs in 2010, according to the National Institutes of Health. Costs are projected to climb to $19 billion in 2020.
“The rapidly increasing costs of prostate cancer treatment driven by a combination of advanced surgical, radiation, and pharmaceutical technologies, has catalyzed increasing scrutiny regarding current treatment approaches for prostate cancer. In fact, prostate cancer has been described as the litmus test for healthcare spending reform efforts,” wrote Joseph C. Hodges, MD, MBA, of the department of radiation oncology at UT Southwestern Medical Center in Dallas, and colleagues.
Hodges and colleagues sought to compare the cost-effectiveness of SBRT with IMRT for a 70-year-old patient with organ-confined prostate cancer. The researchers constructed a Markov model and completed a Monte Carlo simulation.
The analysis demonstrated mean costs for SBRT and IMRT were $22,152 and $35,431, respectively. Both treatment options were associated with quality-adjusted life-years (QALY) of 7.9 years.
However, small changes in cost, quality of life and efficacy impacted the equation. If patients treated with SBRT experienced a 4 percent decrease in quality of life or 6 percent decrease in efficacy, SBRT no longer delivered superior cost-effectiveness, Hodges et al wrote. Using the revised outcomes, IMRT neared the societal willingness to pay threshold of $50,000 per QALY.
Between 35,000 and 46,000 men with organ-confined prostate cancer elect radiation treatment annually, according to Hodges and colleagues. At $13,000 in per-patient savings, if half of these patients were treated with SBRT instead of IMRT, societal savings could reach $250 million annually, they estimated. The researchers also noted indirect cost savings linked with SBRT as it reduces lost time from work and treatment-related transportation and housing costs.
Despite these rosy early indications, Hodges and colleagues acknowledged efficacy and long-term toxicity data on SBRT are accumulating, which could modify the results. Future studies, including a currently enrolling Radiation Therapy Oncology Group trial comparing quality of life at one year of 5-fraction SBRT with 12-fraction IMRT, should shed additional light on these questions.