727 860
Nguyen (2011)
[39]
N
not given
for IMRT and
3D-CRT
Retrospective
cohort study
SEER-Medicare
2002–2005
IMRT versus
3D-CRT
Medicare payments
in the year after
diagnosis minus
those in the year
prior to diagnosis
Medicare payments
(did not look at
indirect costs)
Payer
(Medicare)
Mean IMRT cost in 2002:$37 125 (2008)
Mean 3D-CRT cost in 2002: $22 384 (2008)
Difference: $14 741 (2008)
Mean IMRT cost in 2005: $31 574 (2008)
Mean 3D-CRT cost in 2005: $20 588 (2008)
Difference: $10 986 (2008)
Risk of bias high. No adjusted models were
constructed. IMRT patients were younger,
healthier, more often nonwhite; live in higher
educated and more urban areas; live in areas
with higher median incomes; do not live in the
south or midwest; and are less likely to have
higher stage disease.
Hummel (2012)
[84]
NA
Cost modeling
(lifetime
perspective)
Data from systematic
review
IMRT versus
3D-CRT
Costs modeled in
decision tree
analyses
Direct and indirect
costs
UK National
Health Service
perspective
Baseline age 70 yr
Mean IMRT cost: £5921 (2009)
Mean 3D-CRT cost: £4799 (2009)
Difference: £1122 (2009)
In scenarios where survival is greater with
IMRT, IMRT was cost effective (ICER
<
£20 000).
When only a difference in late GI toxicity was
assumed, the ICER was highly sensitive to
uncertain model parameters.
Univariate sensitivity analyses performed on
key parameters, such as age, incremental cost
of IMRT in comparison with 3D-CRT, and
duration of late GI toxicity.
Limitation: There are limited clinical data
comparing IMRT and 3D-CRT.
Risk of bias moderate due to uncertainty of the
data abstracted from the literature.
Yong (2012)
[40]
NA
Cost modeling
(lifetime time
horizon)
Data from systematic
review and survey from
radiation oncologists and
physicists for estimated
pretreatment preparation
time
IMRT versus
3D-CRT
Costs estimated
through activity-
based costing with
input from radiation
oncologists,
physicists, and
treatment planners
(Markov model)
Direct costs plus cost
of equipment
(capital,
construction,
maintenance and
operating costs), cost
of supplies,
personnel, and
overhead costs
Payer
(Canadian
health care
system)
Baseline age 70 yr
Mean IMRT cost: C$14 520 (2009)
Mean 3D-CRT cost: C$13 509 (2009)
Difference: C$1019 (2009)
ICER: C$26 768/QALY
Assumes equal biochemical survival between
IMRT and 3D-CRT, but lower frequency of GI
toxicity for IMRT. Assumes a treatment dose of
>
70 Gy. Cost estimate is for a mature program.
Sensitivity analyses were conducted to assess
the robustness of the model results and to
evaluate the cost effectiveness of IMRT in
different scenarios.
Limitations: Assumes the same dose. Some feel
that IMRT’s advantage lies not in its technique
but in the ability to give a higher dose; cost of
GI toxicity based on a survey of a few radiation
oncologists.
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
727