Cost minimization analysis of single institution randomized trial
Background: Hypofractionated prostate radiation reduces treatment duration with outcomes comparable to conventional radiation, but little data exist that supports the persistent value of hypofractionated radiation after taking into account costs associated with management of late radiation toxicity. We report a cost minimization comparison of conventional intensity modulated radiation (CIMRT) to dose-escalated hypofractionated intensity modulated radiation (HIMRT), taking into account management of late radiation toxicity, to determine if long-term cost efficiency persists. Patients and Methods: A decision tree was used to model probabilities of maximum late bowel and urinary toxicities from a randomized trial. Men with organ-confined prostate cancer were treated with 75.6Gy in1.8Gy fractions or 72Gy in 2.4Gy fractions. Costs were estimated from an institutional healthcare perspective, using 2014 national payment rates for healthcare services utilized from trial report and chart review. Estimates were verified with patient level billing costs, adjusted to 2014 US dollars. Sensitivity analysis assessed model uncertainty. Results: The expected cost for HIMRT and late toxicity management was $22,957, with a cost savings benefit of approximately $7,000 compared to CIMRT ($30,241). CIMRT was the common factor among the 5 most influential parameters contributing to total costs of radiotherapy and toxicity management. Late toxicity comprises a small part (<10%) of total cost for patients who develop either late grade 2 or 3 bowel or urinary toxicity. Toxicity management may reach up to 26% of total cost, based on 4 patients with higher grade bowel and urinary toxicities. There was no threshold at which CIMRT became more cost efficient compared to HIMRT. Billing cost confirmed HIMRT as the less costly strategy (cost savings of $6,000). Conclusions: Cost analysis suggest that dose-escalated hypofractionated prostate radiation, even after taking into account costs added to therapy due to late radiation toxicity, remains the more cost efficient strategy when compared to conventional radiation.
Voong, Khinh Ranh, "Cost minimization analysis of single institution randomized trial" (2014). Texas Medical Center Dissertations (via ProQuest). AAI1569945.