Paper Information

In the base case scenario, PCI was not cost-effective in this model with an ICER of $168,456 per QALY gained compared to MRI surveillance alone, assuming that overall survival was 10 months and 12.5 months for MRI surveillance alone and PCI, respectively. One-way sensitivity analysis showed that results were most sensitive to the variation of overall survival and cognitive decline rates between the two groups. In a scenario analysis, when all patients receive hippocampal-avoidance PCI (HA-PCI), the model results become near cost effective with PCI.

PCI was not found to be cost effective within this model compared to MRI surveillance alone due to the neurocognition decline impact of PCI based on available evidence. HA-PCI may be a potential cost-effective strategy for ES-SCLC, with expected confirmation following ongoing prospective clinical trial (SWOG MAVERICK), which includes assessments of cognitive function.

Due to conflicting prospective data, controversy exists regarding prophylactic cranial irradiation (PCI) in extensive stage small cell lung cancer (ES-SCLC). We evaluate the cost effectiveness of PCI versus MRI surveillance for patients with ES-SCLC based on currently available evidence and in the context of the purposed CMS alternative payment model.

A Markov state transition model was constructed to perform a cost-effectiveness analysis comparing MRI surveillance alone with PCI for ES-SCLC. Clinical parameters were obtained from clinical trial data, and cost data were based on 2019 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio (ICER) with effectiveness in quality-adjusted life years (QALYs) and evaluated with a willingness to pay threshold of $100,000 per QALY gained. One-way and probabilistic sensitivity analyses were performed to consider model uncertainty.