Cost-effectiveness Analysis of Preoperative Versus Postoperative Radiotherapy in Extremity Soft Tissue Sarcoma
Menée à l'aide d'un modèle de Markov basé sur les résultats d'un essai canadien incluant 190 patients atteints d'un sarcome des tissus mous des extrémités, cette étude analyse le rapport coût-efficacité d'une radiothérapie post-opératoire par rapport à une radiothérapie pré-opératoire
Purpose : Surgery combined with radiotherapy (RT) is the cornerstone of multi-disciplinary management of extremity soft tissue sarcoma (STS). Although RT can be given in either the preoperative or postoperative setting with similar local recurrence and survival outcomes, side effect profiles, costs and long-term functional outcomes are different. The aim of this study is to use decision analysis to determine optimal sequencing of RT with surgery in patients with extremity STS.
Methods and Materials : A cost-effectiveness analysis was conducted using a state transition Markov model, with quality adjusted life years (QALYs) as the primary outcome. A time horizon of 5 years, cycle length of 3 months and a willingness-to-pay threshold of $50,000/QALY was used. One-way deterministic sensitivity analyses were performed to determine the thresholds at which each strategy would be preferred. The robustness of the model was assessed by probabilistic sensitivity analysis.
Results : Preoperative RT is a more cost-effective strategy ($26,633/3.00 QALYs) when compared to postoperative RT ($28,028/2.86 QALYs) in our base case scenario. Preoperative RT is the superior strategy with either 3D conformal or Intensity-Modulated Radiation Therapy. One-way sensitivity analyses identified the relative risk of chronic complications as having the greatest influence on the preferred timing of RT. The likelihood of preoperative RT being the preferred strategy was 82% on probabilistic sensitivity analysis.
Conclusions : Preoperative RT is more cost-effective than postoperative RT in the management of resectable extremity STS, primarily due to the higher incidence of chronic complications with RT in the postoperative setting.
International Journal of Radiation Oncology • Biology • Physics , résumé, 2015