Cost-utility analysis of short- versus long-course palliative radiotherapy in patients with non-small-cell lung cancer

Abstract

Background: Radiotherapy can effectively palliate the symptoms of poor-prognosis patients with non-small-cell lung cancer. However, controversy remains about whether short-course or more protracted radiotherapy schedules provide better value for the money. We conducted a societal cost-utility analysis of a Dutch multicenter randomized trial with 1-year follow-up that compared the efficacy of radiotherapy schedules consisting of 10 fractions of 3 Gy (10 × 3 Gy) versus two fractions of 8 Gy (2 × 8 Gy) in 297 patients with inoperable stage IIIA/B or stage IV non-small-cell lung cancer. This trial found that the 10 × 3-Gy group had better survival than the 2 × 8-Gy group. Methods: Lifetime quality-adjusted life-years (QALYs) were estimated using the EuroQol questionnaire. Lifetime societal costs were estimated using a model estimated based on data from cost questionnaires filled out by a subset of patients (n = 56). Differences were analyzed statistically using two-sided nonparametric bootstrapping. Results: Compared with the 2 × 8-Gy group, the 10 × 3-Gy group accrued statistically significantly more QALYs (20.0 versus 13.2 weeks; difference = 6.8 weeks, 95% confidence interval [CI] = 0.1 to 13.5 weeks, P = .05), which was mainly due to the statistically significantly better survival (38.1 versus 27.4 weeks; difference = 10.7 weeks, 95% CI = 0.9 to 20.6 weeks, P = .03) without a statistically significant difference with respect to the average valuation of health (P = .27). Total radiotherapy and radiotherapy-related costs were estimated at $5236 for the 10 × 3-Gy group and $2512 for the 2 × 8-Gy group (difference = $2724, 95% CI = $2501 to $2947, P