Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer

• DOI: 10.1016/j.radonc.2022.02.036
• Publication Date: 2022-03-05T15:58:33Z
• Authors: Willem J.A. Witlox; Bram L.T. Ramaekers; Benjamin Lacas; Cecile Le Pechoux; Alexander Sun; Si-Yu Wang; Chen Hu; Mary Redman; Vincent van der N...; Ning Li; Matthias Guckenbe...; Harm van Tinteren; Lizza E.L. Hendriks; Harry J.M. Groen; Manuela A. Joore; Dirk K.M. De Ruys...
• Keywords: Prophylactic cranial irradiation; Incremental cost-effectiveness ratio

In stage III non-small cell lung cancer (NSCLC), prophylactic cranial irradiation (PCI) reduces the brain metastases incidence and prolongs progression-free survival without improving overall survival. PCI increases risk of toxicity is currently not adopted in routine care. Our objective was to assess cost-effectiveness compared with no NSCLC from a Dutch societal perspective.A cohort partitioned model developed based on individual patient data three randomized phase trials (N = 670). Quality-adjusted life years (QALYs) costs were estimated over lifetime time horizon. A willingness-to-pay (WTP) threshold €80,000 per QALY adopted. Sensitivity scenario analyses performed address parameter uncertainty explore what parameters had greatest impact results.PCI more effective costly (0.443 QALYs, €10,123) than PCI, resulting an incremental ratio (ICER) €22,843 gained. The probability being cost-effective at WTP 93%. gaining six additional months 76% 56%. analysis adding durvalumab increased ICER €35,159 Using alternative distributions little ICER. Assuming fewer fractions excluding indirect decreased €18,263 €5554 gained.PCI NSCLC, could therefore, perspective, be considered