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Cost-effectiveness of treating head and neck cancer using intensity-modulated radiation therapy: implications for cancer control program in India

Published online by Cambridge University Press:  23 September 2020

Akashdeep Singh Chauhan ,
Shankar Prinja Open the ORCID record for Shankar Prinja [Opens in a new window] ,
Sushmita Ghoshal  and
Roshan Verma
Akashdeep Singh Chauhan
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Shankar Prinja
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Sushmita Ghoshal
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Roshan Verma
Affiliation:
Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Background

The newer cancer treatment technologies hold the potential of providing improved health outcomes at an additional cost. So it becomes obligatory to assess the costs and benefits of a new technology, before defining its clinical value. We assessed the cost-effectiveness of intensity-modulated radiotherapy (IMRT) as compared to 2-dimensional radiotherapy (2-DRT) and 3-dimensional radiotherapy (3D-CRT) for treating head and neck cancers (HNC) in India. The cost-effectiveness of 3-DCRT as compared to 2-DRT was also estimated.

Methods

A probabilistic Markov model was designed. Using a disaggregated societal perspective, lifetime study horizon and 3 percent discount rate, future costs and health outcomes were compared for a cohort of 1000 patients treated with any of the three radiation techniques. Data on health system cost, out of pocket expenditure, and quality of life was assessed through primary data collected from a large tertiary care public sector hospital in India. Data on xerostomia rates following each of the radiation techniques was extracted from the existing randomized controlled trials.

Results

IMRT incurs an incremental cost of $7,072 (2,932–13,258) and $5,164 (463–10,954) per quality-adjusted life year (QALY) gained compared to 2-DRT and 3D-CRT, respectively. Further, 3D-CRT as compared to 2-DRT requires an incremental cost of $8,946 (1,996–19,313) per QALY gained.

Conclusion

Both IMRT and 3D-CRT are not cost-effective at 1 times GDP per capita for treating HNC in India. The costs and benefits of using IMRT for other potential indications (e.g. prostate, lung) require to be assessed before considering its introduction in India.

Keywords

Cost-effectiveness analysisIntensity-modulated radiation therapy3-Dimensional conformal radiotherapy2-Dimensional radiotherapyHead and neck cancers
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 36 , Issue 5 , October 2020 , pp. 492 - 499
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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