• 10/5/2004
  • Andre A. Konski et al.
  • Fox Chase Cancer Center

Intensity-modulated radiation therapy (IMRT)–the newest generation of precision-targeted, conformal radiation therapy–permits delivery of powerful radiation doses with extremely high precision while reducing radiation side effects on surrounding healthy tissue. However, because the technology is much more expensive to deliver than the previous conformal therapy, three-dimensional conformal radiation therapy (3-D CRT), there have been concerns about cost-effectiveness.

A Fox Chase Cancer Center study presented today at the 46th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Atlanta, Ga., looked at prostate cancer treatment with IMRT and found it cost-effective because of the reduction in side effects and extended disease-free survival, requiring fewer additional treatments with either hormone therapy or chemotherapy.

“Although more expensive, our study found IMRT to be cost-effective for men with intermediate-risk prostate cancer because it improved the quality-adjusted survival,” said lead author Andre A. Konski, M.D., M.B.A., M.A., a radiation oncologist and clinical director of the Prostate Cancer Risk Assessment Program at Fox Chase.

To determine if the benefits to patients are worth the cost from a payer’s point of view, Fox Chase Cancer Center researchers developed a model to compare 3-D CRT to IMRT for a 70-year-old man with prostate cancer who has an intermediate-risk that the cancer would recur or progress.

The disease states modeled included (1) no disease progression; (2) disease progression that responded to hormone therapy; (3) disease progression that did not respond or stopped responding to hormone therapy and therefore required chemotherapy; and (4) complete failure of therapy and death. The study adjusted years of survival to reflect quality of life, thus measuring quality-adjusted life years.

“In our analysis, the expected mean cost of patients having IMRT was $52,170 with a survival of 7.62 quality-adjusted life years,” Konski said. “The expected mean cost of patients having 3-D CRT was $27,357 with a survival of 6.65 quality-adjusted life years. Compared to CRT, the incremental cost-effectiveness of IMRT was $25,580 for the additional quality-adjusted life year.”

This cost-effectiveness measure is well below the limit of $50,000 per quality-adjusted life year commonly accepted by health economists to determine cost-effectiveness, Konski pointed out. A sensitivity analysis found that increasing the radiation dose per day by using hypofractionated radiation further enhanced cost-effectiveness of IMRT.

“Higher doses of radiation could be given with potentially greater quality-adjusted survival because of fewer side effects from IMRT,” Konski explained. “Longer follow-up of patients treated with IMRT will allow further adjustments of the model.”

This type of decision analysis can help inform physicians and health policy experts about the cost-effectiveness of emerging technologies before the completion of comparative randomized trials, the Fox Chase researchers concluded. In addition to Konski, study authors included Deborah Watkins-Bruner, Ph.D., director of the Prostate Cancer Risk Assessment Program, radiation oncologist Steven J. Feigenberg, M.D., statistician Alexandra L. Hanlon, Ph.D., risk-assessment project manager Sachin Kulkarni, J. Robert Beck, M.D., vice president for information technology and chief information officer, and radiation oncology chairman Alan Pollack, M.D., Ph.D.