An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared With Conventional Palliative RT for Spinal Metastases.

Kerba, M; Lourenco, RDA; Sahgal, A; Cardet, RDF; Siva, S; Ding, K; Myrehaug, SD; Masucci, GL; Brundage, M; Parulekar, WR

An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared With Conventional Palliative RT for Spinal Metastases.

Kerba, M Lourenco, RDA Sahgal, A Cardet, RDF Siva, S Ding, K Myrehaug, SD Masucci, GL Brundage, M Parulekar, WR

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Int J Radiat Oncol Biol Phys, 2024, 119, (4), pp. 1061-1068
Issue Date:: 2024-07-15

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Field	Value	Language
dc.contributor.author	Kerba, M
dc.contributor.author	Lourenco, RDA
dc.contributor.author	Sahgal, A
dc.contributor.author	Cardet, RDF
dc.contributor.author	Siva, S
dc.contributor.author	Ding, K
dc.contributor.author	Myrehaug, SD
dc.contributor.author	Masucci, GL
dc.contributor.author	Brundage, M
dc.contributor.author	Parulekar, WR
dc.date.accessioned	2024-11-19T03:44:22Z
dc.date.available	2023-12-31
dc.date.available	2024-11-19T03:44:22Z
dc.date.issued	2024-07-15
dc.identifier.citation	Int J Radiat Oncol Biol Phys, 2024, 119, (4), pp. 1061-1068
dc.identifier.issn	0360-3016
dc.identifier.issn	1879-355X
dc.identifier.uri	http://hdl.handle.net/10453/181983
dc.description.abstract	PURPOSE: The Canadian Cancer Trials Group (CCTG) Symptom Control 24 protocol (SC.24) was a multicenter randomized controlled phase 2/3 trial conducted in Canada and Australia. Patients with painful spinal metastases were randomized to either 24 Gy/2 stereotactic body radiation therapy (SBRT) or 20 Gy/5 conventional external beam radiation therapy (CRT). The study met its primary endpoint and demonstrated superior complete pain response rates at 3 months following SBRT (35%) versus CRT (14%). SBRT planning and delivery is resource intensive. Given its benefits in SC.24, we performed an economic analysis to determine the incremental cost-effectiveness of SBRT compared with CRT. METHODS AND MATERIALS: The trial recruited 229 patients. Cost-effectiveness was assessed using a Markov model taking into account observed survival, treatments costs, retreatment, and quality of life over the lifetime of the patient. The EORTC-QLU-C10D was used to determine quality of life values. Transition probabilities for outcomes were from available patient data. Health system costs were from the Canadian health care perspective and were based on 2021 Canadian dollars (CAD). The incremental cost-effectiveness ratio (ICER) was expressed as the ratio of incremental cost to quality-adjusted life years (QALY). The impact of parameter uncertainty was investigated using deterministic and probabilistic sensitivity analyses. RESULTS: The base case for SBRT compared with CRT had an ICER of $9,040CAD per QALY gained. Sensitivity analyses demonstrated that the ICER was most sensitive to variations in the utility assigned to "No local failure" ($5,457CAD to $241,051CAD per QALY), adopting low and high estimates of utility and the cost of the SBRT (ICERs ranging from $7345-$123,361CAD per QALY). It was more robust to variations in assumptions around survival and response rate. CONCLUSIONS: SBRT is associated with higher upfront costs than CRT. The ICER shows that, within the Canadian health care system, SBRT with 2 fractions is likely to be more cost-effective than CRT.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Int J Radiat Oncol Biol Phys
dc.relation.isbasedon	10.1016/j.ijrobp.2023.12.052
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	0299 Other Physical Sciences, 1103 Clinical Sciences, 1112 Oncology and Carcinogenesis
dc.subject.classification	Oncology & Carcinogenesis
dc.subject.classification	3211 Oncology and carcinogenesis
dc.subject.classification	3407 Theoretical and computational chemistry
dc.subject.classification	5105 Medical and biological physics
dc.subject.mesh	Humans
dc.subject.mesh	Radiosurgery
dc.subject.mesh	Cost-Benefit Analysis
dc.subject.mesh	Spinal Neoplasms
dc.subject.mesh	Palliative Care
dc.subject.mesh	Canada
dc.subject.mesh	Markov Chains
dc.subject.mesh	Quality of Life
dc.subject.mesh	Quality-Adjusted Life Years
dc.subject.mesh	Male
dc.subject.mesh	Female
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Middle Aged
dc.subject.mesh	Aged
dc.subject.mesh	Humans
dc.subject.mesh	Spinal Neoplasms
dc.subject.mesh	Palliative Care
dc.subject.mesh	Radiosurgery
dc.subject.mesh	Markov Chains
dc.subject.mesh	Quality-Adjusted Life Years
dc.subject.mesh	Quality of Life
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	Cost-Benefit Analysis
dc.subject.mesh	Canada
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Humans
dc.subject.mesh	Radiosurgery
dc.subject.mesh	Cost-Benefit Analysis
dc.subject.mesh	Spinal Neoplasms
dc.subject.mesh	Palliative Care
dc.subject.mesh	Canada
dc.subject.mesh	Markov Chains
dc.subject.mesh	Quality of Life
dc.subject.mesh	Quality-Adjusted Life Years
dc.subject.mesh	Male
dc.subject.mesh	Female
dc.subject.mesh	Cancer Pain
dc.subject.mesh	Middle Aged
dc.subject.mesh	Aged
dc.title	An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared With Conventional Palliative RT for Spinal Metastases.
dc.type	Journal Article
utslib.citation.volume	119
utslib.location.activity	United States
utslib.for	0299 Other Physical Sciences
utslib.for	1103 Clinical Sciences
utslib.for	1112 Oncology and Carcinogenesis
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/INSIGHT: Institute for Innovative Solutions for Well-being and Health/Centre for Health Economics Research and Evaluation (CHERE)
pubs.organisational-group	University of Technology Sydney/UTS Groups/INSIGHT: Institute for Innovative Solutions for Well-being and Health
pubs.organisational-group	University of Technology Sydney/UTS Groups/Centre for Health Technologies (CHT)
utslib.copyright.status	closed_access	*
dc.date.updated	2024-11-19T03:44:21Z
pubs.issue	4
pubs.publication-status	Published
pubs.volume	119
utslib.citation.issue	4

Abstract:

PURPOSE: The Canadian Cancer Trials Group (CCTG) Symptom Control 24 protocol (SC.24) was a multicenter randomized controlled phase 2/3 trial conducted in Canada and Australia. Patients with painful spinal metastases were randomized to either 24 Gy/2 stereotactic body radiation therapy (SBRT) or 20 Gy/5 conventional external beam radiation therapy (CRT). The study met its primary endpoint and demonstrated superior complete pain response rates at 3 months following SBRT (35%) versus CRT (14%). SBRT planning and delivery is resource intensive. Given its benefits in SC.24, we performed an economic analysis to determine the incremental cost-effectiveness of SBRT compared with CRT. METHODS AND MATERIALS: The trial recruited 229 patients. Cost-effectiveness was assessed using a Markov model taking into account observed survival, treatments costs, retreatment, and quality of life over the lifetime of the patient. The EORTC-QLU-C10D was used to determine quality of life values. Transition probabilities for outcomes were from available patient data. Health system costs were from the Canadian health care perspective and were based on 2021 Canadian dollars (CAD). The incremental cost-effectiveness ratio (ICER) was expressed as the ratio of incremental cost to quality-adjusted life years (QALY). The impact of parameter uncertainty was investigated using deterministic and probabilistic sensitivity analyses. RESULTS: The base case for SBRT compared with CRT had an ICER of $9,040CAD per QALY gained. Sensitivity analyses demonstrated that the ICER was most sensitive to variations in the utility assigned to "No local failure" ($5,457CAD to $241,051CAD per QALY), adopting low and high estimates of utility and the cost of the SBRT (ICERs ranging from $7345-$123,361CAD per QALY). It was more robust to variations in assumptions around survival and response rate. CONCLUSIONS: SBRT is associated with higher upfront costs than CRT. The ICER shows that, within the Canadian health care system, SBRT with 2 fractions is likely to be more cost-effective than CRT.

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http://hdl.handle.net/10453/181983