Cost and effectiveness of image-guided radiotherapy for non-operated localized lung cancer: a population-based propensity score-matched analysis

摘要

Background: Image-guided radiotherapy (IGRT) is a novel technology to enhance RT delivery accuracy. However, the clinical effectiveness and cost-effectiveness are less clear. The aim of our study is to compare the cost and effectiveness of conventional fractionated RT for non-operated localized lung cancer delivered with vs. without IGRT via this population-based propensity score (PS) matched analysis. Methods: We identified eligible patients diagnosed within 2007-2010 through a comprehensive population-based database containing cancer, death registries, and reimbursement data in Taiwan. The primary duration of interest (DOI) was 2 years within diagnosis. Effectiveness was measured as survival whereas direct medical cost was measured from the payers’ perspective. In supplementary analysis (SA), we estimated the cost-effectiveness in consider of out-of-pocket (OOP) payment and 4 years as DOI. Results: Our study population constituted 124 patients. Within 2 years, both the mean cost (2014 USD) and survival (life-year, LY) were higher for IGRT ($60,774 vs . $60,554; 1.43 vs . 1.37). The incremental cost-effectiveness ratio (ICER) when IGRT was compared to non-IGRT was 3,667 (USD/LY). The chance for IGRT to be cost-effective was around 68% & 70% at willingness-to-pay threshold 50,000 USD/LY and 150,000 USD/LY respectively. IGRT remained cost-effective in SA. Conclusions: We provide the first empirical evidence that when compared to non-IGRT, IGRT was potentially cost-effective.