Abstract
ObjectivesStage I non-small cell lung cancer (NSCLC) can be treated with either Stereotactic Body Radiotherapy (SBRT) or Video Assisted Thoracic Surgery (VATS) resection. To support decision making, not only the impact on survival needs to be taken into account, but also on quality of life, costs and cost-effectiveness. Therefore, we performed a cost-effectiveness analysis comparing SBRT to VATS resection with respect to quality adjusted life years (QALY) lived and costs in operable stage I NSCLC. Materials and methodsPatient level and aggregate data from eight Dutch databases were used to estimate costs, health utilities, recurrence free and overall survival. Propensity score matching was used to minimize selection bias in these studies. A microsimulation model predicting lifetime outcomes after treatment in stage I NSCLC patients was used for the cost-effectiveness analysis.Model outcomes for the two treatments were overall survival, QALYs, and total costs. We used a Dutch health care perspective with 1.5 % discounting for health effects, and 4 % discounting for costs, using 2018 cost data. The impact of model parameter uncertainty was assessed with deterministic and probabilistic sensitivity analyses. ResultsPatients receiving either VATS resection or SBRT were estimated to live 5.81 and 5.86 discounted QALYs, respectively. Average discounted lifetime costs in the VATS group were €29,269 versus €21,175 for SBRT. Difference in 90-day excess mortality between SBRT and VATS resection was the main driver for the difference in QALYs. SBRT was dominant in at least 74 % of the probabilistic simulations. ConclusionUsing a microsimulation model to combine available evidence on survival, costs, and health utilities in a cost-effectiveness analysis for stage I NSCLC led to the conclusion that SBRT dominates VATS resection in the majority of simulations.
Highlights
Stage I Non-Small Cell Lung Cancer (NSCLC) has a relatively good prognosis of 81 % or 73 % 5-year survival following curative treatments [1]
We present a Dutch cost-effectiveness analysis comparing Video Assisted Thoracic Surgery (VATS) resection and Stereotactic Body Radiation Therapy (SBRT) in stage I NSCLC, bringing together evidence on effectiveness, quality of life and costs in a microsimulation model
This cost-effectiveness analysis of SBRT versus VATS resection in stage I NSCLC patients found that SBRT is slightly more effective (0.05 quality adjusted life years (QALY)), and less expensive (-€8,095) than VATS
Summary
Stage I Non-Small Cell Lung Cancer (NSCLC) has a relatively good prognosis of 81 % (stage IA) or 73 % (stage IB) 5-year survival following curative treatments [1]. The most commonly used procedures follow current guidelines, which suggest operable patients should preferably be treated with the appropriate thoracoscopic resection technique with Video Assisted Thoracic Surgery (VATS), while Stereotactic Body Radiation Therapy (SBRT) is preferred in inoperable patients [2,3,4]. These guidelines are based on current evidence, there is disagreement whether there is equipoise for operable patients between SBRT and VATS resection. The POSTLIV and VALOR RCTs on clearly operable NSCLC patients are expected to publish their results in 2026 [10]
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