A Cost-Utility Analysis Comparing MR-Guided Brachytherapy to Standard 2D Brachytherapy for Patients With Locally Advanced Cervical Cancer in Ontario, Canada

Abstract

The standard treatment for locally advanced cervical cancer in Ontario is external beam radiotherapy and concurrent cisplatin with 2D brachytherapy (2DBT). Magnetic resonance image-guided intracavitary and interstitial brachytherapy (MRgBT) improves cure rates and reduces treatment side effects compared to 2DBT, and is increasingly recognized as the new standard of care. This study was undertaken to evaluate the cost-effectiveness of implementing best-practice MRgBT compared to 2DBT in Ontario. A Markov model was used for the cost-utility analysis (CUA) from the perspective of a public payer (government) with a five-year time horizon. The CUA evaluated treatment effectiveness, expressed as quality adjusted life years (QALYs), and costs, expressed in 2016 Canadian dollars, for MRgBT and 2DBT. All parameters were obtained from published literature and reviewed by a clinical expert panel were reported as incremental cost-effectiveness ratios comparing MRgBT to 2DBT, for all patients combined, and separately for low (FIGO Stages IA-IIA) and high-risk (FIGO Stages IIB-IV) patients. Parameter uncertainty was explored using sensitivity analyses. MRgBT was the dominant strategy (more effective and less costly) compared to 2DBT for the full population and for both subgroups. The incremental effectiveness was 0.35, 0.19, and 0.43 QALYs per patient for the full population, low-risk subgroup, and high-risk subgroup respectively. The corresponding per patient incremental cost-savings were $1,892, $134, and $2,643 respectively. From the deterministic sensitivity analysis, varying the model parameter values individually did not significantly influence the conclusions. The probabilistic sensitivity analysis provided further evidence to support the robustness of the model and the stability of the findings. MRgBT is a more effective and less costly than 2DBT even when uncertainties in the parameters are considered. From a public payer perspective, implementation of this technology cannot be justifiably withheld on the basis of cost. These findings will provide guidance to health care providers and policy-makers in Ontario with future infrastructure and human resource planning to assure optimal care of women with cervix cancer.