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Estimating the benefit and cost of radiotherapy for lung cancer

Published online by Cambridge University Press:  01 November 2004

Lisa Barbera
Affiliation:
Toronto Sunnybrook Regional Cancer Centre
Hugh Walker
Affiliation:
Queen's University Cancer Research Institute
Farshad Foroudi
Affiliation:
The Peter MacCallum Cancer Centre
Scott Tyldesley
Affiliation:
British Columbia Cancer Agency
William Mackillop
Affiliation:
Queen's University Cancer Research Institute

Abstract

Purpose: To estimate the benefit and cost of using radiotherapy (RT) in the initial management of lung cancer in the general population.

Methods: We identified indications for RT in the initial management of small cell and non–small cell lung cancer through a review of the literature. The proportion of patients with each specific indication for treatment was determined using epidemiological observations from cancer registry data and from the literature. We estimated the benefit gained from RT use for each indication in the model using values published in the literature. We estimated the cost of RT for each indication using published Canadian data. The total benefit and cost was calculated for all indications combined. Results are reported in 2001 Canadian dollars.

Results: The mean benefit was 7 months of survival for each lung cancer patient treated with curative intent and 3 months of symptom control for each patient treated with palliative intent. The average cost was $9,881 per life year gained and $13,938 per year of symptom control gained. Sensitivity analysis revealed values between $7,905 and $19,762 per year of survival gain and between $10,368 and $27,875 per year of symptom control gained.

Conclusions: Using RT in the initial management of lung cancer can provide considerable gains in survival and symptom control. The cost of RT for the initial management of lung cancer is inexpensive compared with a common cut off of $50,000 per life year gained.

Type
GENERAL ESSAYS
Copyright
© 2004 Cambridge University Press

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References

American College of Radiology Task Force on Appropriateness Criteria. 1996. Appropriateness criteria for imaging and treatment decisions in radiation oncology. Reston, VA: American College of Radiology
Auperin A, Arriagada R, Pignon JP, et al. 1999 Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission. Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med. 341: 476484.Google Scholar
Barton MB, Gebski V, Manderson C, Langlands AO. 1995 Radiation therapy: Are we getting value for money? Clin Oncol (R Coll Radiol). 7: 287292.Google Scholar
BC Cancer Agency. Cancer Management Guidelines. Cancer Management Manual. 2001. Available at: www.bccancer.bc.c.
Borgelt B, Gelber R, Kramer S, et al. 1980 The palliation of brain metastases: Final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 6: 19.Google Scholar
Byhardt RW, Scott C, Sause WT, et al. 1998 Response, toxicity, failure patterns, and survival in five Radiation Therapy Oncology Group (RTOG) trials of sequential and/or concurrent chemotherapy and radiotherapy for locally advanced non-small-cell carcinoma of the lung. Int J Radiat Oncol Biol Phys. 42: 469478.Google Scholar
Carmichael J, Crane JM, Bunn PA, Glatstein E, Ihde DC. 1988 Results of therapeutic cranial irradiation in small cell lung cancer. Int J Radiat Oncol Biol Phys. 14: 455459.Google Scholar
Chapman RH, Stone PW, Sandberg EA, Bell C, Neumann PJ. 2000 A comprehensive league table of cost-utility ratios and a sub-table of “panel-worthy” studies. Med Decis Making. 20: 451467.Google Scholar
Computing in Humanities and Social Sciences Facility. Cansim Database. CansimII@chass. 2002. Available at: http://datacenter2.chass.utoronto.ca/cansim/cansim.htm.
Coulter A, Ham C. 2002. The global challenge of health care rationing. Buckingham: Open University Press
Coy P, Schaafsma J, Schofield JA. 2000 The cost-effectiveness and cost-utility of high-dose palliative radiotherapy for advanced non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 48: 10251033.Google Scholar
Dillman RO, Seagren SL, Propert KJ, et al. 1990 A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med. 323: 940945.Google Scholar
Dunscombe P, Roberts G, Walker J. 1999 The cost of radiotherapy as a function of facility size and hours of operation. Br J Radiol. 72: 598603.Google Scholar
Durrant KR, Berry RJ, Ellis F, et al. 1971 Comparison of treatment policies in inoperable bronchial carcinoma. Lancet. 1: 715719.Google Scholar
Earle C, Coyle D, Smith A, Agboola O, Evans WK. 1999 The cost of radiotherapy at an Ontario regional cancer centre: A re-evaluation. Crit Rev Oncol-Hematol. 32: 8793.Google Scholar
Earle CC, Chapman RH, Baker CS, et al. 2000 Systematic over-view of cost-utility assessments in oncology. J Clin Oncol. 18: 33023317.Google Scholar
Ettinger DS, Cox JD, Ginsberg RJ, et al. 1996 NCCN Non-Small-Cell Lung Cancer Practice Guidelines. The National Comprehensive Cancer Network. Oncology (Huntingt). 10: 81111.Google Scholar
Evans WK, Will BP, Berthelot JM, Earle CC. 1997 Cost of combined modality interventions for stage III non-small-cell lung cancer [see comments]. J Clin Oncol. 15: 30383048.Google Scholar
Evans WK, Will BP, Berthelot JM, Wolfson MC. 1995 Diagnostic and therapeutic approaches to lung cancer in Canada and their costs. Br J Cancer. 72: 12701277.Google Scholar
Evans WK, Will BP, Berthelot JM, Wolfson MC. 1996 The economics of lung cancer management in Canada. Lung Cancer. 14: 1929.Google Scholar
Glazebrook GA. 1992 Radiation therapy: A long term cost benefit analysis in a North American region. Clin Oncol (R Coll Radiol). 4: 302305.Google Scholar
Goddard M, Hutton J. 1991 Economic evaluation of trends in cancer therapy. Marginal or average costs? Int J Technol Assess Health Care. 7: 594603.Google Scholar
Goodwin PJ, Feld R, Evans WK, Pater J. 1988 Cost-effectiveness of cancer chemotherapy: An economic evaluation of a randomized trial in small-cell lung cancer. J Clin Oncol. 6: 15371547.Google Scholar
Komaki R, Scott CB, Sause WT, et al. 1997 Induction cisplatin/vinblastine and irradiation vs. irradiation in unresectable squamous cell lung cancer: Failure patterns by cell type in RTOG 88-08/ECOG 4588. Radiation Therapy Oncology Group. Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys. 39: 537544.Google Scholar
Laupacis A, Feeny D, Detsky AS, Tugwell PX. 1992 How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J. 146: 473481.Google Scholar
Le Chevalier T, Arriagada R, Quoix E, et al. 1991 Radiotherapy alone versus combined chemotherapy and radiotherapy in nonresectable non-small-cell lung cancer: First analysis of a randomized trial in 353 patients. J Natl Cancer Inst. 83: 417423.Google Scholar
Mathers CD, Boschi-Pinto C, Lopez AD, Murray CJ. 2001. Cancer incidence, mortality and survival by site for 14 different regions of the world. (Discussion Paper 13) In: Global programme on evidence for health policy. Geneva: World Health Organization;
Medical Research Council. 1991 Inoperable non-small-cell lung cancer (NSCLC): A Medical Research Council randomised trial of palliative radiotherapy with two fractions or ten fractions. Report to the Medical Research Council by its Lung Cancer Working Party. Br J Cancer. 63: 265270.
National Cancer Institute, CancerNet: A service of the National Cancer Institute. 2002. PDQ Cancer Information Summaries: Treatment. Monograph on-line. Available at: http://cancernet.nci.nih.gov/pdq/pdq_treatment.shtm.
Pignon JP, Arriagada R, Ihde DC, et al. 1992 A meta-analysis of thoracic radiotherapy for small-cell lung cancer. N Engl J Med. 327: 16181624.Google Scholar
PORT Meta-analysis Trialists Group. 1998 Postoperative radiotherapy in non-small-cell lung cancer: Systematic review and meta-analysis of individual patient data from nine randomised controlled trials. PORT Meta-analysis Trialists Group. Lancet. 352: 257263.
Pritchard RS, Anthony SP. 1996 Chemotherapy plus radiotherapy compared with radiotherapy alone in the treatment of locally advanced, unresectable, non-small-cell lung cancer. A meta-analysis. Ann Intern Med. 125: 723729.Google Scholar
Roswit B, Patno ME, Rapp R, et al. 1968 The survival of patients with inoperable lung cancer: A large-scale randomized study of radiation therapy versus placebo. Radiology. 90: 688697.Google Scholar
Sackett DL. 1989 Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 95: 2S4S.Google Scholar
Schaafsma J, Coy P. 1998 The effect of radiotherapy on the survival of non-small cell lung cancer patients. Int J Radiat Oncol Biol Phys. 41: 291298.Google Scholar
Schaafsma J, Coy P. 2000 Response of global quality of life to high-dose palliative radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 47: 691701.Google Scholar
Schaake-Koning C, van den Bogaert W, Dalesio O, et al. 1992 Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer. N Engl J Med. 326: 524530.Google Scholar
Scottish Intercollegiate Guidelines Network. 1998. Management of Lung Cancer. Monograph on-line. Available at: www.show.scot.nhs.uk/sign/html/htmtxt23.ht.
Stephens RJ, Girling DJ, Bleehen NM, et al. 1996 The role of post-operative radiotherapy in non-small-cell lung cancer: A multicentre randomised trial in patients with pathologically staged T1-2, N1-2, M0 disease. Medical Research Council Lung Cancer Working Party. Br J Cancer. 74: 632639.Google Scholar
Stevens G, Firth I. 1997 Audit in radiation therapy: Long-term survival and cost of treatment. Australas Radiol. 41: 2934.Google Scholar
Tong D, Gillick L, Hendrickson FR. 1982 The palliation of symptomatic osseous metastases: Final results of the study by the Radiation Therapy Oncology Group. Cancer. 50: 893899.Google Scholar
Tyldesley S, Boyd CJ, Schulze K, Walker H, Mackillop WJ. 2001 Estimating the need for radiotherapy for lung cancer: An evidence based, epidemiological approach. Int J Radiat Oncol Biol Phys. 49: 973985.Google Scholar
Wodinsky HB, Jenkin RD. 1987 The cost of radiation treatment at an Ontario regional cancer centre. CMAJ. 137: 906909.Google Scholar