Cost-Effectiveness of Single Versus Multifraction SABR for Pulmonary Oligometastases: The SAFRON II Trial
- Author(s)
- De Abreu Lourenco, R; Khoo, T; Crothers, A; Haas, M; Montgomery, R; Ball, D; Bressel, M; Siva, S;
- Details
- Publication Year 2022-12-01,Volume 114,Issue #5,Page 968-976
- Journal Title
- International Journal of Radiation Oncology, Biology, Physics
- Publication Type
- Research article
- Abstract
- PURPOSE: The use of stereotactic ablative body radiation therapy (SABR) in advanced cancer care is increasing, yet the cost-effectiveness of single-fraction (SF) versus multifraction (MF) SABR in pulmonary oligometastases is unknown. METHODS: A prespecified cost-effectiveness analysis was conducted of the Trans Tasman Radiation Oncology Group 13.01 - SAFRON II - randomized trial comparing SF with MF SABR in 87 patients with 133 pulmonary oligometastases. A partitioned survival model assessed costs and quality-adjusted life-years (QALY) over the within-trial period (4 years) and longer-term (10 years). Costs reflected a societal perspective, expressed in Australian dollars (A$) using 2020 prices and were estimated using patient level data on health care utilization for radiation therapy (including patient time), post-radiation systemic therapy and treatment of adverse effects. Quality of life was assessed using the EuroQoL EQ-5D-5L. The incremental cost-effectiveness ratio (ICER) was expressed as the cost per QALY gained for SF versus MF SABR, with uncertainty assessed using deterministic and probabilistic sensitivity analyses. RESULTS: SF cost less than MF for initial therapy (difference of A$1194/patient). Mean time to initiation of systemic drug therapy did not differ between arms (P = .94). Numerical differences in survival favoring SF resulted in greater overall health care use for the within-trial period. The within-trial ICER was A$15,821/QALY and A$23,265/QALY over the longer term. Results were most sensitive to the cost of postprogression therapies and utility values. The sensitivity analysis indicated that SF SABR has a 97% probability of being cost-effective at a willingness-to-pay of A$50,000/QALY. CONCLUSIONS: SF has lower initial costs and is highly likely to be cost-effective. Time to initiation of systemic therapy associated with disease progression is highly patient relevant and is a major driver of cost-effectiveness. Comparisons for SF SABR with nonradiation therapy approaches to the treatment of pulmonary oligometastases warrant further investigation.
- Keywords
- Humans; Australia; Cost-Benefit Analysis; *Quality of Life; Quality-Adjusted Life Years; *Radiosurgery
- Department(s)
- Radiation Oncology; Biostatistics and Clinical Trials
- PubMed ID
- 36395809
- Publisher's Version
- https://doi.org/10.1016/j.ijrobp.2022.01.024
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2025-01-24 05:56:59
Last Modified: 2025-01-24 05:58:22