A Cost-Utility Analysis of Magnetic Resonance (MR) Guided Brachytherapy Versus Two-Dimensional and Computed Tomography (CT) Guided Brachytherapy for Locally Advanced Cervical Cancer

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  • Johnna Perdrizet, University of Toronto
  • ,
  • David D'Souza, Western University
  • ,
  • Julia Skliarenko, South Muskoka Regional Cancer Program, University of Toronto
  • ,
  • Michelle Ang, Cancer Care Ontario
  • ,
  • Lisa Barbera, Tom Baker Cancer Centre
  • ,
  • Eric Gutierrez, Cancer Care Ontario
  • ,
  • Ananth Ravi, University of Toronto
  • ,
  • Kari Tanderup
  • Padraig Warde, Cancer Care Ontario
  • ,
  • Kelvin Chan, University of Toronto, Canadian Centre for Applied Research in Cancer Control
  • ,
  • Wanrudee Isaranuwatchai, University of Toronto, Canadian Centre for Applied Research in Cancer Control
  • ,
  • Michael Milosevic, University of Toronto, University Health Network

Purpose: The standard treatment for locally advanced cervical cancer is external beam radiation therapy and concurrent cisplatin followed by brachytherapy. Traditionally, 2-dimensional brachytherapy (2DBT) or computed tomography guided brachytherapy (CTgBT) has been used, but magnetic resonance guided brachytherapy (MRgBT) improves clinical outcomes and has become the new standard of care. This cost-utility analysis was undertaken to compare MRgBT to CTgBT and 2DBT. Methods and Materials: A Markov model was constructed to evaluate the cost-utility from the perspective of the public health care payer in Ontario. Treatment effectiveness, expressed as quality-adjusted life years, and costs, expressed in 2016 Canadian dollars, were evaluated for MRgBT, CTgBT, and 2DBT. Results were reported as incremental cost-effectiveness ratios for all patients and separately for low and high-risk subgroups. Sensitivity analyses were performed to assess the impact of uncertainty in model parameters. Results: MRgBT improved tumor control, reduced side effects, and was less costly compared with either CTgBT or 2DBT for all patients and in low- and high-risk prognostic subgroups separately. Sensitivity analysis supported the robustness of the findings and identified the cost of treating cancer recurrence to be the single most influential model parameter. Conclusions: MRgBT is more effective and less costly than CTgBT or 2DBT by avoiding downstream costs of treating cancer recurrence and managing side effects. These findings will assist health care providers and policymakers with future infrastructure and human resource planning to ensure optimal care of women with this disease.

OriginalsprogEngelsk
TidsskriftInternational Journal of Radiation Oncology Biology Physics
Vol/bind107
Nummer3
Sider (fra-til)512-521
Antal sider10
ISSN0360-3016
DOI
StatusUdgivet - 2020

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