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Cost‐effectiveness analysis of neurocognitive‐sparing treatments for brain metastases
Author(s) -
Savitz Samuel T.,
Chen Ronald C.,
Sher David J.
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29642
Subject(s) - medicine , neurocognitive , oncology , intensive care medicine , cognition , psychiatry
BACKGROUND Decisions regarding how to treat patients who have 1 to 3 brain metastases require important tradeoffs between controlling recurrences, side effects, and costs. In this analysis, the authors compared novel treatments versus usual care to determine the incremental cost‐effectiveness ratio from a payer's (Medicare) perspective. METHODS Cost‐effectiveness was evaluated using a microsimulation of a Markov model for 60 one‐month cycles. The model used 4 simulated cohorts of patients aged 65 years with 1 to 3 brain metastases. The 4 cohorts had a median survival of 3, 6, 12, and 24 months to test the sensitivity of the model to different prognoses. The treatment alternatives evaluated included stereotactic radiosurgery (SRS) with 3 variants of salvage after recurrence (whole‐brain radiotherapy [WBRT], hippocampal avoidance WBRT [HA‐WBRT], SRS plus WBRT, and SRS plus HA‐WBRT). The findings were tested for robustness using probabilistic and deterministic sensitivity analyses. RESULTS Traditional radiation therapies remained cost‐effective for patients in the 3‐month and 6‐month cohorts. In the cohorts with longer median survival, HA‐WBRT and SRS plus HA‐WBRT became cost‐effective relative to traditional treatments. When the treatments that involved HA‐WBRT were excluded, either SRS alone or SRS plus WBRT was cost‐effective relative to WBRT alone. The deterministic and probabilistic sensitivity analyses confirmed the robustness of these results. CONCLUSIONS HA‐WBRT and SRS plus HA‐WBRT were cost‐effective for 2 of the 4 cohorts, demonstrating the value of controlling late brain toxicity with this novel therapy. Cost‐effectiveness depended on patient life expectancy. SRS was cost‐effective in the cohorts with short prognoses (3 and 6 months), whereas HA‐WBRT and SRS plus HA‐WBRT were cost‐effective in the cohorts with longer prognoses (12 and 24 months). Cancer 2015;121:4231–4239. © 2015 American Cancer Society .