726 860
Table 2 – Studies comparing cost of IMRT and 3D-CRT
Study
Patients,
no.
Type of
study
Data source
Comparison
Cost definition Costs included
(direct vs indirect)
Perspective Main findings including comment on risk of
bias
Studies from the payer’s perspective
Konski (2005)
[41]
NA
Cost modeling
(10-yr timeline)
Hospital billing data,
patient questionnaires
IMRT versus
3D-CRT
Costs modeled in
decision tree
analyses (Markov
model)
Direct costs
(Medicare
reimbursements);
did not look at
copays or
deductibles
Payer
(Medicare)
70 yr old with intermediate risk
Mean IMRT cost: $33 837 (2004)
Mean 3D-CRT cost: $21 377 (2004)
Difference: $12 460 (2004)
ICER: $16 182/QALY
70 yr old with good risk
Mean IMRT cost: $31 950 (2004)
Mean 3D-CRT cost: $19 213 (2004)
Difference: $12 737 (2004)
ICER: $17 448/QALY
Sensitivity analysis found that a longer time
horizon and younger age favorably impacted
the cost-effectiveness ratio.
Probabilistic sensitivity analysis was
performed to address uncertainty concerning
cost, transition probabilities, and utilities using
a second-order Monte Carlo simulation.
Risk of bias moderate due to uncertainty of the
data abstracted from the literature.
Konski (2006)
[83]
NA
Cost modeling Literature review,
patient questionnaires,
or preference at
institution
IMRT versus
3D-CRT
Costs modeled in
decision tree
analyses (Markov
model)
Direct costs
Payer
(Medicare)
70 yr old with intermediate-risk prostate
cancer
Mean IMRT cost: $47 931 (2004)
Mean 3D-CRT cost: $21 865 (2004)
Difference: $26 066 (2004)
ICER: $40 101/QALY
IMRT has 53% probability of being cost
effective if the ICER for deciding cost
effectiveness is $50 000/QALY. The results,
however, are dependent on the assumptions of
improved biochemical disease-free survival
with fewer patients undergoing salvage
therapy and improved QOL after treatment.
The results are sensitive to the time horizon of
the analysis and the utilities used to inform the
model.
Probabilistic sensitivity analysis was
performed to address uncertainty concerning
cost, transition probabilities, and utilities using
a second-order Monte Carlo simulation.
Risk of bias moderate due to uncertainty of the
data abstracted from the literature.
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 7 1 2 – 7 3 5
726