Economic analysis of radiation therapy oncology group 97-14: multiple versus single fraction radiation treatment of patients with bone metastases

Abstract

Introduction: Radiation Therapy Oncology Group 97-14 concluded that a single fraction of radiation was as effective in relieving pain as multiple fractions in the treatment of patients with bone metastases. A statistically significant higher retreatment rate, however, was noted in patients undergoing a single fraction treatment. The purpose of the analysis was to determine whether multiple fraction treatment is cost-effective in treating patients with bone metastasis, by preventing further retreatment.

Methods and material: A Markov model was used to evaluate the cost-effectiveness of 30 Gy in 10 fractions in comparison with 8 Gy in 1 fraction. Transition probabilities, cost, and utilities were obtained from the clinical trial. Costs and outcomes were not discounted because of the short time line for the study.

Results: The expected mean cost and quality-adjusted survival in months for patients receiving 8 Gy in 1 fraction and 30 Gy in 10 fractions was 998 US dollars and 7.26 months and 2316 US dollars and 9.53 months, respectively. The incremental cost-effectiveness ratio was 6973 US dollars/quality-adjusted life year. The results were sensitive to the utility of the posttreatment state for both single and multiple fraction treatments.

Conclusion: Single fraction treatment was the less expensive treatment in the treatment of patients with bone metastasis treated on Radiation Therapy Oncology Group 97-14.

Figures

Figure 1

This figure depicts the flow of patients in the model for a single fraction treatment. Patients start out at SRT or single radiation treatment and then move through the model as determined by the transition probabilities. Each cyle through the model was 1 month in length.

Figure 2

This figure depicts the flow of patients in the model for multiple fractions. Patients start out in MRT or multiple radiation treatments and move through the model as determined by the transitions probabilities.

Figure 3

This figure shows the cost-effective acceptability curve. The probability that multiple fractions of radiation would be cost-effective compared to a single fraction at $3,334/Quality-Adjusted Life Month was 100%.