Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression

Journal Article · Wed Nov 15 04:00:00 EST 2006 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.06.021· OSTI ID:20850241

Thomas, Kenneth C ^[1]; Nosyk, Bohdan ^[2]; Fisher, Charles G ^[3]; Dvorak, Marcel ^[3]; Patchell, Roy A ^[4]; Regine, William F ^[5]; Loblaw, Andrew ^[6]; Bansback, Nick ^[2]; Guh, Daphne ^[2]; Sun, Huiying ^[2]; Anis, Aslam ^[7]

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1. Departments of Surgery (Orthopedics) and Neurosciences, University of Calgary, Calgary, AB (Canada)
2. Center for Health Evaluation and Outcome Sciences, Vancouver, BC (Canada)
3. Department of Orthopedics, University of British Columbia, Vancouver, BC (Canada)
4. Departments of Surgery (Neurosurgery) and Neurology, University of Kentucky Medical Center, Lexington, KY (United States)
5. Department of Radiation Oncology, University of Maryland Medical School, Baltimore, MD (United States)
6. Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)
7. Center for Health Evaluation and Outcome Sciences, Vancouver, BC (Canada) and Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC (Canada)

Purpose: A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches. Methods and Materials: In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death. In this study, an incremental cost-effectiveness analysis was performed from a societal perspective. Costs related to treatment and posttreatment care were estimated and extended to the lifetime of the cohort. Weibull regression was applied to extrapolate outcomes in the presence of censored clinical effectiveness data. Results: From a societal perspective, the baseline incremental cost-effectiveness ratio (ICER) was found to be $60 per additional day of ambulation (all costs in 2003 Canadian dollars). Using probabilistic sensitivity analysis, 50% of all generated ICERs were lower than $57, and 95% were lower than $242 per additional day of ambulation. This analysis had a 95% CI of -$72.74 to 309.44, meaning that this intervention ranged from a financial savings of $72.74 to a cost of $309.44 per additional day of ambulation. Using survival as the measure of effectiveness resulted in an ICER of $30,940 per life-year gained. Conclusions: We found strong evidence that treatment of metastatic epidural spinal cord compression with surgery in addition to radiotherapy is cost-effective both in terms of cost per additional day of ambulation, and cost per life-year gained.

• OSTI ID: 20850241
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 66; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CLINICAL TRIALS
COST
DEATH
METASTASES
NEOPLASMS
PROBABILISTIC ESTIMATION
RADIOTHERAPY
SENSITIVITY ANALYSIS
SPINAL CORD
SURGERY
SURVIVAL TIME