Cost-effectiveness of patient-specific motion management strategy in lung cancer radiation therapy planning

Abstract Cost-effectiveness analysis (CEA) in medicine is a form of economic study that compares the relative value of medical technologies and health care services. It helps decision makers to formally evaluate proposed interventions and make informed choices based on the estimated health gains per dollar spent under each intervention. This study employs a CEA framework to assess an emerging imaging technology to determine whether its adoption will be appropriate in routine patient care. A significant challenge in lung cancer radiotherapy (RT) is respiration-induced tumor motion during positron emission tomography/computed tomography (PET/CT). Respiratory gating may improve the image quality and delivery of curative doses to tumor. Respiratory-gated PET/CT is especially useful for locally advanced and inoperable non–small cell lung cancer (NSCLC). Due to the heterogeneity in patients’ respiratory patterns, questions remain regarding who will benefit from respiratory gating. The effectiveness of respiratory gating can be measured by using quantitative improvements in PET/CT images. We previously developed a patient-specific motion management (PSMM) paradigm to identify patients who benefited from respiratory-gated PET/CT based on respiratory pattern analysis. This article presents a new CEA framework to evaluate the cost-effectiveness of PSMM compared to the population-based radiation oncology practice of motion management in more than 1,500 cancer patients.