Early Health Economic Analysis of 1.5T MRI-guided Radiotherapy for Localized Prostate Cancer

Abstract

Purpose or Objective 1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac) is gaining interest for treatment of localized prostate cancer. Evidence of clinical effectiveness is still lacking and it therefore remains uncertain whether MR-Linac is cost-effective. An early health economic analysis was performed to calculate the necessary relative reduction in complications and the maximum price of MR-Linac treatment (5 fractions) to be cost-effective compared to 5, 20 and 39 fractionation schedules of external beam radiotherapy (EBRT) and low-dose-rate (LDR) brachytherapy. Materials and Methods A state transition model was developed for men with localized prostate cancer. Quality adjusted life years (QALYs), costs and incremental cost-effectiveness ratios of MR-Linac and comparators were calculated over lifetime. Complication rates such as grade ≥2 urinary, grade ≥2 bowel and sexual complications, and utilities were based on systematic literature searches. Costs were estimated from literature using a Dutch healthcare perspective. Threshold analyses were performed to identify the thresholds of complications and costs for MR- Linac to be cost-effective. One-way sensitivity analyses were performed to outline uncertainty outcomes of all parameters. Results At a cost price of €6,460 per patient, no reductions in complications were needed to consider MR-Linac cost-effective compared to EBRT 20 and 39 fractions. Compared to EBRT 5 fractions and LDR brachytherapy, MR-Linac is found to be cost-effective when complications are relatively reduced by 54% and 66% respectively. Sensitivity analyses showed that the results are highly sensitive to the utilities of urinary, bowel and sexual complications and the probability of biochemical progression. Conclusion MR-Linac is likely to be cost-effective compared to 20 and 39 fractions EBRT. For MR-Linac to become cost-effective compared to 5 fractions EBRT and LDR brachytherapy, it has to either reduce complications substantially or be offered at limited costs.