Abstract

Background and purpose1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Clinical evidence is lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy. Materials and methodsA state transition model was developed for men with localized prostate cancer. Complication rates such as grade ≥2 urinary, grade ≥2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR-Linac to be cost-effective, while holding other outcomes such as biochemical progression and mortality constant. One-way sensitivity analyses were performed to outline uncertainty outcomes. ResultsAt €6460 per patient, no reductions in complications were needed to consider MR-Linac cost-effective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression. ConclusionsMR-Linac is found to be cost-effective compared to 20 and 39 fractions EBRT at baseline. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs.

Highlights

  • Background and purpose1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MRLinac) is gaining interest for treatment of localized prostate cancer

  • If MR-Linac costs €6460 per patient, no additional reductions in grade !2 urinary, grade !2 bowel and sexual complications were needed for MR-Linac to be found cost-effective compared to external beam radiotherapy (EBRT) 20 and 39 fractions (Table 3)

  • MR-Linac appears to be cost-effective compared to 5-fractions EBRT when grade !2 urinary, grade !2 bowel and sexual complications are reduced by at least 54%. c, probability of acute and late urinary complications will need to be reduced from 23.8% to 11% and from 18% to 8% respectively

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Summary

Introduction

Background and purpose1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MRLinac) is gaining interest for treatment of localized prostate cancer. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy. Materials and methods: A state transition model was developed for men with localized prostate cancer. Complication rates such as grade !2 urinary, grade !2 bowel and sexual complications, and utilities were based on systematic literature searches. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac was found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. For MR-Linac to become cost-effective over 5 fractions EBRT and LDR brachytherapy, it has to reduce complications substantially or be offered at lower costs.

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