Cost-Utility Analysis of Stereotactic Body Radiation Therapy Versus Surgery for Patients With Stage I Non-small Cell Lung Cancer in Japan

IF 6.5 1区医学 Q1 ONCOLOGY International Journal of Radiation Oncology Biology Physics Pub Date : 2025-01-01 Epub Date: 2024-09-29 DOI:10.1016/j.ijrobp.2024.07.2328

Ataru Igarashi PhD , Hiroshi Onishi PhD, MD , Yoshiyuki Shioyama PhD, MD , Yasuo Matsumoto PhD, MD , Kenji Takayama MD , Yukinori Matsuo PhD, MD , Hideomi Yamashita PhD, MD , Akifumi Miyakawa PhD, MD , Haruo Matsushita PhD, MD , Masahiko Aoki PhD, MD , Keiji Nihei PhD, MD , Tomoki Kimura PhD, MD , Ritsuko Koba MSc , David W. Lee PhD , Kaoru Ito PhD

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Abstract

Purpose

Stereotactic body radiation therapy (SBRT) for patients with operable stage I non-small cell lung cancer (NSCLC) is less invasive than surgery. However, differences in lifetime costs and patient outcomes remain unclear. In this study, a cost-utility analysis of SBRT compared with surgery for Japanese patients with operable stage I NSCLC was conducted.

Methods and Materials

A partitioned survival model was constructed using each treatment arm's overall survival (OS) and progression-free survival (PFS) data. The data for the SBRT arm were extracted from the Japanese multicenter cohort study, which enrolled 678 medically operable patients with stage I NSCLC, and patient registry data were used for the surgery arm. The 5-year OS rate was 78.2% for SBRT and 74.8% for surgery from both studies. The 5-year PFS rate was 57.0% for SBRT and 63.4% for surgery. The quality of life values of PFS and progressive disease were obtained from domestic and overseas literature (PFS: 0.74, progressive disease: 0.65). The time horizon was set to 10 years. The expected costs and quality-adjusted life years for each treatment group were calculated. All costs are expressed in Japanese yen converted to US dollars (USD).

Results

SBRT was the dominant strategy, reducing treatment costs by 4,443.8 USD and increasing quality-adjusted life years by 0.131 compared with surgery. According to probabilistic sensitivity analysis, the probability of SBRT being dominant and cost-effective was 50.6% and 72.4%, respectively. Under the budget impact analysis, the total savings for the patients with stage I NSCLC in Japan was 6,252,870.0 USD (n = 1,407).

Conclusions

SBRT is a more cost-effective option than surgery in patients with medically operable stage I NSCLC in Japan. Large-scale epidemiologic studies that reflect the latest clinical realities, such as OS/PFS, will be needed to validate this study's robustness.

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日本 I 期非小细胞肺癌患者接受立体定向体外放射治疗与手术治疗的成本效用分析。

目的：对可手术的 I 期非小细胞肺癌（NSCLC）患者进行立体定向体放射治疗（SBRT）比手术创伤更小。然而，终生成本和患者预后的差异仍不明确。本研究对日本可手术 I 期 NSCLC 患者进行了 SBRT 与手术相比的成本效用分析：利用各治疗组的总生存期（OS）和无进展生存期（PFS）数据构建了一个分区生存模型。SBRT治疗组的数据摘自日本多中心队列研究，该研究共纳入了678例可接受内科手术的I期NSCLC患者，手术治疗组则使用了患者登记数据。在这两项研究中，SBRT 的 5 年 OS 率为 78.2%，手术的 5 年 OS 率为 74.8%。SBRT的5年PFS率为57.0%，手术为63.4%。PFS和疾病进展的生活质量值来自国内外文献（PFS：0.74，疾病进展：0.65）。时间跨度设定为 10 年。计算了各治疗组的预期成本和质量调整生命年。所有成本均以日元换算成美元表示：与手术相比，SBRT 是最主要的治疗策略，治疗成本降低了 4443.8 美元，质量调整生命年增加了 0.131。根据概率敏感性分析，SBRT 发挥主导作用和具有成本效益的概率分别为 50.6% 和 72.4%。根据预算影响分析，日本I期NSCLC患者共节省了6,252,870.0美元（n = 1,407）：结论：在日本，与手术相比，SBRT 是一种更经济有效的治疗方案，适用于可接受药物治疗的 I 期 NSCLC 患者。要验证这项研究的可靠性，还需要进行大规模的流行病学研究，以反映最新的临床实际情况，如OS/PFS。

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来源期刊

International Journal of Radiation Oncology Biology Physics 医学-核医学

CiteScore

11.00

自引率

7.10%

发文量

2538

审稿时长

6.6 weeks

期刊介绍： International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.