Abstract
Backround: Intrabeam system is a technology used in oncology for intraoperative radiotherapy (IORT), a technique of partial delivery of radiation therapy to the tumour bed during surgery. The aim of this study is to evaluate cost effectiveness of the Intrabeam system compared to the standard treatment with external beam radiotherapy (EBRT) in early stage breast cancer treatment in order to reach a decision on a possible introduction of the technology to the Czech healthcare system. Methods: In order to determine the clinical effects, a worldwide literature review was conducted. The cost of the Intrabeam system was estimated based on available information about acquisitions of the system worldwide in the last 5 years. The cost of treatment was calculated from the perspective of a healthcare payer, and all the information gathered was summarized in a Markov model to finalize the cost-effectiveness calculation. A sensitivity analysis was performed. Results: The input of the model was based on the TARGIT-A pragmatic randomized controlled trial—the largest and most comprehensive study among 26 selected studies from the literature review. The estimated purchase cost of the system for the Czech Republic was determined in the range of CZK 16–20 million without VAT. Based on the findings, three versions (baseline, optimistic, pessimistic) of the calculation for IORT interventions using Intrabeam were determined. In the baseline scenario, the cost of the Intrabeam system intervention was CZK 38 559, the ICER value was CZK 53 483 saved per 1 QALY lost. The results of the sensitivity analysis are consistent with the results of the baseline scenario. The ICER value is not above the cost-effectiveness threshold (currently a little above CZK 1.2 million), which is required to consider the technology cost effective. Conclusion: According to the results of the cost-effectiveness analysis, we do not currently recommend the Intrabeam system to be introduced into the Czech healthcare system.
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