Cost Effectiveness for Stage I Lung Cancer Therapies

Lung cancer researchers have compared the cost effectiveness of standard surgery with stereotactic body radiation therapy (SBRT) for patients with early-stage non–small-cell lung cancer (NSCLC). The results, published in the journal Cancer, show that cost effectiveness depends on whether the patient’s disease is clearly or marginally operable.

Surgical removal of lung tumor; source: Wojciech Filipiak, Wikimedia Commons

The cost-effective choice for patients who had stage I NSCLC that was clearly operable is a lobectomy over a spectrum of different options. For those patients with only marginally operable stage I NSCLC, SBRT was shown to be the most cost-effective option.

Anand Shah, MD, MPH, of the radiation oncology department at Columbia University Medical Center, and colleagues from University of Pennsylvania in Philadelphia and Rush University Medical Center in Chicago, used Medicare Prospective Payment Systems and 2012 Medicare payment rates for both surgery and SBRT to analyze costs and outcomes.

The study authors simulated clinical scenarios of a 65-year-old operable patient.

For patients with marginally operable disease, SBRT had a mean cost of $42,094 per 8.03 quality-adjusted life expectancies, while SBRT for clearly operable patients had a mean cost of $40,107 per 8.21 quality-adjusted life expectancies. A lobectomy had a mean cost of $49,093 per 8.89 quality-adjusted life expectancies. A wedge resection, performed on smaller tumors as an alternative to a lobectomy, had a mean cost of $51,487 per 7.93 quality-adjusted life expectancies.

For patients who were eligible for surgery, a lobectomy was the most cost-effective treatment (incremental cost-effectiveness ratio [ICER] of $13,200 per quality-adjusted life year).

The scenario analyses found that wedge resection came with an extra cost and morbidity, and without a clear disease-control benefit.

The authors found that SBRT was cost-effective up to a willingness to pay of more than $500,000 per quality-adjusted life year.

Whether SBRT can replace surgery, which is more costly, is still an open question.

“Our results strongly suggest cost-effective strategies for both populations. Importantly, these findings could impact a large number of patients with stage I NSCLC,” state the authors.

While this is the first scenario-based cost-effectiveness analysis, other patient data–based studies have shown similar results.

“The consistency of these results provides strong evidence that in a cost-conscious healthcare system, SBRT and lobectomy are clearly the preferred treatment options for medically compromised and medically fit patients, respectively,” conclude the authors.