Cost-effectiveness of stereotactic body radiation therapy versus surgical resection for stage I non–small cell lung cancer

Authors

  • Anand Shah MD, MPH,

    1. Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Radiation Oncology, Columbia University Medical Center, New York, New York
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  • Stephen M. Hahn MD,

    1. Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Robert L. Stetson MHA,

    1. Office of Strategic Decision Support, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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  • Joseph S. Friedberg MD,

    1. Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Taine T. V. Pechet MD,

    1. Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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  • David J. Sher MD, MPH

    Corresponding author
    1. Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
    • Corresponding author: Anand Shah, MD, MPH, Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032; Fax: (212) 305-5935; as4351@columbia.edu

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  • An abstract of this work has been accepted for oral presentation at the annual meeting of the American Society for Radiation Oncology in September 2013.

  • We thank Brian Wildt (Radiation Oncology), Quiana Mack (Surgery), and Mary Ferroni (Anesthesia) at the University of Pennsylvania for their assistance with Medicare coding and payment data.

Abstract

BACKGROUND

The traditional treatment for clearly operable (CO) patients with stage I non–small cell lung cancer (NSCLC) is lobectomy, with wedge resection (WR) and stereotactic body radiation therapy (SBRT) serving as alternatives in marginally operable (MO) patients. Given an aging population with an increasing prevalence of screening, it is likely that progressively more people will be diagnosed with stage I NSCLC, and thus it is critical to compare the cost-effectiveness of these treatments.

METHODS

A Markov model was created to compare the cost-effectiveness of SBRT with WR and lobectomy for MO and CO patients, respectively. Disease, treatment, and toxicity data were extracted from the literature and varied in sensitivity analyses. A payer (Medicare) perspective was used.

RESULTS

In the base case, SBRT (MO cohort), SBRT (CO cohort), WR, and lobectomy were associated with mean cost and quality-adjusted life expectancies of $42,094/8.03, $40,107/8.21, $51,487/7.93, and $49,093/8.89, respectively. In MO patients, SBRT was the dominant and thus cost-effective strategy. This result was confirmed in most deterministic sensitivity analyses as well as probabilistic sensitivity analysis, in which SBRT was most likely cost-effective up to a willingness-to-pay of more than $500,000/quality-adjusted life year. For CO patients, lobectomy was the cost-effective treatment option in the base case (incremental cost-effectiveness ratio of $13,216/quality-adjusted life year) and in nearly every sensitivity analysis.

CONCLUSIONS

SBRT was nearly always the most cost-effective treatment strategy for MO patients with stage I NSCLC. In contrast, for patients with CO disease, lobectomy was the most cost-effective option. Cancer 2013;119:3123–3132. © 2013 American Cancer Society.

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