Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Currently, lobectomy (surgical resection) is the treatment of choice for medically operable Stage I non–small cell lung cancer (NSCLC) patients. A growing body of evidence suggests that stereotactic body radiation therapy (SBRT) may be considered as an option for these patients. We sought to investigate the cost effectiveness of using SBRT versus lobectomy for the management of patients with medically operable Stage I NSCLC from the perspective of the Canadian public healthcare system.
Methods: We developed a Markov model to project the lifetime clinical and economic consequences of operable Stage I NSCLC. We considered 12 scenarios corresponding to male and female patients aged 65 or 70 with minor comorbidity and standard life risk, average comorbidity and light smoking, and major comorbidity and heavy smoking. We assumed that lobectomy is associated with short term postoperative mortality risk and reduction in quality of life. We assumed SBRT is associated with minimal treatment related toxicity and maintenance of quality of life as it has been shown in recent analyses. The model was parameterized using data from clinical trials, 10 year cost data obtained by linking Ontario Cancer Registry with administrative databases in Ontario, and secondary sources. Costs are presented in 2012 CAD. Future costs and benefits were discounted at 5%.
Results: In all scenarios, SBRT led to an increase in quality adjusted life years of survival (QALYs) and a decrease in cost resulting in SBRT being cost saving compared to lobectomy. QALYs gained and cost saving ranged from 0.018 QALY and $25,900 per person for a 65 year old female with minor comorbidities, and up to 0.032 QALY and $26,400 per person for a 70 year old male with major comorbidities and heavy smoking. Results were most sensitive to the changes in the quality of life associated with SBRT.
Conclusions: Our results suggest that SBRT is clinically and economically a promising treatment for patients with operable Stage I NSCLC. These results suggest that SBRT should be considered for adoption for operable Stage I NSCLC. However, ongoing assessment of SBRT effectiveness in real-world Canadian clinical practice is warranted especially with regards to quality of life in these patients.