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The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases

Published online by Cambridge University Press:  23 September 2014

Waseem Sharieff*
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario Department of Radiation Oncology, Cape Breton Regional Cancer Centre, Sydney Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia
Anthony Whitton
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
Tom Chow
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
Doug Wyman
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
James Wright
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
Jeffrey N. Greenspoon
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
*
Department of Radiation Oncology, Cape Breton Regional Cancer Centre, Sydney, Nova Scotia, B1p 1p3, Canada. Email: doc.sharieff@utoronto.ca
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Abstract

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Background:

Radiosurgery can be delivered through a variety of modalities including robotic and fixed gantry linacbased systems. They appear equally effective and safe. Thus, community need and costs remain the main determinants for choosing a given modality. We performed an economic evaluation to identify settings in which one modality could be preferred over the other.

Methods:

Using local estimates of resource volumes and unit prices, we computed the incremental cost/patient of robotic radiosurgery compared to fixed-gantry radiosurgery from a payer's perspective. By varying parameters of resource volumes, we performed a probabilistic analysis stratified by number of brain lesions. in addition, we performed sensitivity analyses to examine the effect of patient volume on cost/patient.

Results:

The cost of robotic radiosurgery was $4,783/patient, and cost of fixed-gantry radiosurgery was $5,166/patient. The mean incremental cost was $-383 (95% interval: $-670, $110) for all lesions, $78 ($23, $123) for solitary lesions, and $-610 ($-679, $-534) for multiple lesions. The cost/patient of robotic radiosurgery varied from $5,656 (low volume setting) to $4,492 (high volume setting).

Conclusion:

in settings of moderate to high volume (6-10 hours of daily operation), and in multiple lesions, robotic radiosurgery is more cost effective than fixed-gantry radiosurgery.

Résumé

RÉSUMÉContexte:

La radiochirurgie peut être administrée au moyen de différentes modalités dont les systèmes robotisés et de type LINAC à portique fixe. Ces modalités de traitement semblent être également efficaces et sûres. Le choix de l'une ou l'autre semble déterminé par les besoins de la communauté et les coûts. Nous avons effectué une évaluation économique pour identifier le contexte dans lequel l'une pourrait être préférée à l'autre.

Méthode:

Nous avons calculé ce que coûterait par patient la radiochirurgie robotisée comparée à la radiochirurgie à portique fixe, du point de vue du payeur, au moyen des estimés locaux du volume des ressources et des prix unitaires. En variant les paramètres du volume des ressources, nous avons effectué une analyse probabiliste stratifiée selon le nombre de lésions cérébrales à traiter. De plus, nous avons effectué des analyses de sensibilité pour examiner l'effet du volume de patients sur le coût par patient.

Résultats:

Le coût de la radiochirurgie robotisée était de 4 783$ par patient et le coût de la radiochirurgie à portique fixe était de 5 166$ par patient. Le coût additionnel moyen était de -383$ (intervalle de confiance à 95% : -670$ à 110$) pour toutes les lésions, 78$ (23$ à 123$) pour les lésions uniques et -610$ (-679$ à -534$) pour les lésions multiples. Le coût par patient de la radiochirurgie robotisée variait de 5 656$ (si le volume était faible) à 4 492$ (si le volume était élevé).

Conclusion:

Si le volume est de modéré à élevé et en opération de 6 à 10 heures par jour, la radiochirurgie robotisée est plus avantageuse au point de vue économique que la radiochirurgie à portique fixe pour traiter les lésions multiples.

Type
Original Article
Copyright
Copyright © The Canadian Journal of Neurological 2013

References

1. Pickren, JW, Lopez, G, Tzukada, Y, et al. Brain metastases: an autopsy study. Cancer Treat Symp. 2003;2:295313.Google Scholar
2. Posner, JB, Chernik, NL. Intracranial metastases from systemic cancer. Adv Neurol. 1978;19:57992.Google Scholar
3. Andrews, DW, Scott, CB, Sperduto, PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomized trial. Lancet. 2004;363:166572.Google Scholar
4. Cqco.on.ca. Toronto: Cancer Quality Council of Ontario; c2002 [cited 2012 Dec 25]. Available from: http://www.csqi.on.ca/ Google Scholar
5. Boudreau, R, Clark, M, Nkansah, E. TomoTherapy, GammaKnife and CyberKnife therapies for patients with tumours of the lung, central nervous system, or inta-abdomen: a systematic review of clinical effectiveness and cost-effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2009.Google Scholar
6. Wowra, B, Muacevic, A, Tonn, J. Quality of radiosurgery for single brain metastases with respect to treatment technology: a matched-pair analysis. J Neurooncol. 2009;94:6977.Google Scholar
7. Diaz-Santos, NC, Amaro, JAB, Cardiel, GA, et al. The safety and efficacy of robotic image-guided radiosurgery system treatment for intra- and extracranial lesions: a systematic review of the literature. Radiother Oncol. 2009;89:24553.Google Scholar
8. Regis, J, Manabu, T, Cicile, G, et al. Radiosurgery with the world's first fully robotized Leskell GammaKnife PerfeXion in clinical use: a 200-patient prospective, randomized, controlled comparison with the GammaKnife 4C. Neurosurgery. 2009;64: 34656.Google Scholar
9. Sharieff, W, Greenspoon, J, Newton, T, et al. Stereotactic radiation for brain metastases with Cyberknife: The Hamilton Experience. Presented at the Radiosurgery Society Annual Scientific Meeting, San Diego, CA, February 14–15, 2013.Google Scholar
10. Health.gov.on.ca. Toronto: Ministry of Health and Long-Term Care; c2002. [updated 2013 February 4; cited 2012 December 15]. Available from: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html.Google Scholar
11. Clinicaltrials.gov. Bethesda: National library of Medicine, the National Institutes of Health; c2000–02 [updated 2011 May 12; cited 2012 December 31]. Available from: http://clinicaltrial.gov/ct2/show/NCT01353573?term=greenspoon&rank=1.Google Scholar
12. Lal, L, Byfield, S, Chang, E, et al. Cost-effectiveness analysis of a randomized study comparing radiosurgery with radiosurgery and whole brain radiation therapy in patients with 1 to 3 brain metastases. Am J Clin Oncol. 2012;35(1):4550.Google Scholar
13. Mehta, M, Noyes, W, Craig, B, et al. A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases. Int J Radiat Oncol Biol Phys. 1997;39:44554.Google Scholar
14. Vuong, DA, Rades, D, van Eck, AT, Horstmann, GA, Busse, R. Comparing the cost-effectiveness of two brain metastasis treatment modalities from a payer's perspective: stereotactic radiosurgery versus surgical resection. Clin Neurol Neurosurg. 2013;115(3):27684.Google Scholar
15. Königsmaier, H, de Pauli-Ferch, B, Hackl, A, Pendl, G. The costs of radiosurgical treatment: comparison between gamma knife and linear accelerator. Acta Neurochir (Wien). 1998;140(11):110110.Google Scholar