728 860
Table 2 (
Continued
)
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
Carter (2014)
[44]
NA
Cost modeling
(20-yr timeline)
Data from systematic
review, a series of
component studies, and
a workshop
IMRT versus
3D-CRT in the
postprostatectomy
setting
Markov decision
model
Direct health care
costs (did not
include capital costs)
Australian
health care
system
Average patient age 65 yr
Mean IMRT cost: $32 816
Mean 3D-CRT cost: $33 917
Difference: $–1101
ICER: $41 572/QALY
(no year for inflation adjustment)
Performed a series of one-way and
probabilistic sensitivity analysis.
IMRT was found to be more effective and less
costly than 3D-CRT. However, the differences
are small, and cost utility analyses over a long
follow-up period are highly dependent on
assumptions about toxicity and costs of
treating these.
Limitation: Heavy reliance on clinical
judgment to generate inputs for the model due
to a lack of published evidence.
Risk of bias moderate due to uncertainty of the
data abstracted from the literature.
Cooperberg (2013)
[35] NA
Cost utility
analyses
Review of the published
literature to estimate
outcomes
IMRT versus
3D-CRT
Decision-analytic
Markov model to
evaluate QALYs, and
lifetime costs. Costs
for visits and
procedures derived
from the
2009 National
Medicare Fee
schedule
Direct costs and
sensitivity analyses
incorporating cost to
patient (time of
work)
Payer
(Medicare)
Average patient age 65 yr
Direct medical IMRT cost: $27 084 (2009)
Direct medical 3D-CRT cost: $13 013 (2009)
Difference: $14 071 (2009)
IMRT was found to be significantly more
effective than 3D-CRT among patients with
low-risk disease (0.5 QALYs gained). No ICER
calculated.
Limitation: Multiple assumptions underlie the
model.
Risk of bias low, as sensitivity analyses
changing many assumptions did not change
the outcome of the analyses.
Yong (2016)
[42]
NA
Cost modeling Data from literature
review and consulting
with radiation oncologists,
physicists, and radiation
therapists
IMRT versus
3D-CRT
Costs estimated
through activity-
based costing
Direct costs plus cost
of equipment
(capital,
construction,
maintenance and
operating costs), cost
of supplies,
personnel, and
overhead costs
Payer
(Canadian
health care
system)
Mean IMRT cost: C$12 834 (2009)
Mean 3D-CRT cost: C$12 453 (2009)
Difference: C$381 (2009)
Tested various scenarios by varying the
program maturity and the use of volumetric
modulated arc therapy alongside IMRT, longer
dosimetry time for IMRT, longer quality
assurance for IMRT.
In the start-up scenario, the incremental cost of
IMRT increased by a factor of 11 ($4268 vs
$381), which highlights the importance of
evaluating timing.
Risk of bias moderate due to cost estimates
derived from two centers in Ontario.
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
728