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Cost-effectiveness analysis of 3D image-guided brachytherapy compared with 2D brachytherapy in the treatment of locally advanced cervical cancer.

Abstract

IGBT for locally advanced cervical cancer is a C/E option compared with 2D brachytherapy. These findings were robust to variation of parameter values supporting the routine use of IGBT in locally advanced cervical cancer.

A Markov model was constructed to model locally advanced cervical cancer treated with five fractions of high-dose-rate brachytherapy. The model captured clinical parameters, quality of life utility, and treatment costs through the literature review. Costs were 2013 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life-years (QALYs). To account for uncertainty, one-way, two-way, and probabilistic sensitivity analyses were performed. Strategies were evaluated from a payer's perspective with a willingness-to-pay threshold of $50,000/QALY gained.

Treatment costs for five fractions of IGBT and 2D brachytherapy were $21,374 and $17,931, respectively. In the base-case analysis, the IGBT strategy costs $3003 more than 2D brachytherapy while gaining 0.16 QALYs, resulting in an ICER of $18,634 per QALY gained. In one-way sensitivity analyses, results were most sensitive to variation of treatment costs, but the ICER remained <$50,000/QALY gained for all cost ranges. Variation of survival, local control, and complication rates was less influential. A probabilistic sensitivity analysis demonstrated that IGBT was favored in 63% of model iterations at a $50,000/QALY gained threshold.

Three-dimensional image-guided brachytherapy (IGBT) is a significant advance in locally advanced cervical cancer treatment. However, its cost-effectiveness (C/E) is unknown. We performed a C/E analysis of IGBT compared with conventional (two-dimensional [2D]) brachytherapy in the treatment of locally advanced cervical cancer.

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