Cost-Effectiveness of Single Versus Multifraction SABR for Pulmonary Oligometastases: The SAFRON II Trial

De Abreu Lourenco, R; Khoo, T; Crothers, A; Haas, M; Montgomery, R; Ball, D; Bressel, M; Siva, S

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.

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