TY - JOUR
T1 - Is SABR Cost-Effective in Oligometastatic Cancer? An Economic Analysis of the SABR-COMET Randomized Trial
T2 - An economic analysis of the SABR-COMET randomized trial
AU - Qu, X. Melody
AU - Chen, Yujie
AU - Zaric, Gregory S.
AU - Senan, Suresh
AU - Olson, Robert A.
AU - Harrow, Stephen
AU - John-Baptiste, Ava
AU - Gaede, Stewart
AU - Mulroy, Liam A.
AU - Schellenberg, Devin
AU - Senthi, Sashendra
AU - Swaminath, Anand
AU - Kopek, Neil
AU - Liu, Mitchell
AU - Warner, Andrew
AU - Rodrigues, George B.
AU - Palma, David A.
AU - Louie, Alexander V.
N1 - Funding Information: Dr Louie’s research is supported through the Ontario Association of Radiation Oncology Clinician Scientist program . Dr Palma’s research is supported by the Ontario Institute for Cancer Research . This study received funding from the 2019 Radiation Oncology Institution Publication Award. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Funding Information: Dr Louie's research is supported through the Ontario Association of Radiation Oncology Clinician Scientist program. Dr Palma's research is supported by the Ontario Institute for Cancer Research. This study received funding from the 2019 Radiation Oncology Institution Publication Award. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Disclosures: S.S. has received grant funding from ViewRay Inc and Varian Medical Systems Inc and honoraria from AstraZeneca, Celgene, and MSD, unrelated to this research project. R.O. has received grant funding from Varian Medical Systems Inc, unrelated to this research project. D.S. has received grant funding from Varian Medical Systems Inc and honoraria from AstraZeneca, Bayer, and Merck, unrelated to this research project. A.S. has received grant funding from Bristol-Myers-Squibb and Accuray, unrelated to this research project. A.V.L. has received honoraria from Varian Medical Systems Inc, AstraZeneca, and RefleXion, unrelated to this research project. The other authors declare no competing interests. Funding Information: Disclosures: S.S. has received grant funding from ViewRay Inc and Varian Medical Systems Inc and honoraria from AstraZeneca, Celgene, and MSD, unrelated to this research project. R.O. has received grant funding from Varian Medical Systems Inc, unrelated to this research project. D.S. has received grant funding from Varian Medical Systems Inc and honoraria from AstraZeneca, Bayer, and Merck, unrelated to this research project. A.S. has received grant funding from Bristol-Myers-Squibb and Accuray, unrelated to this research project. A.V.L. has received honoraria from Varian Medical Systems Inc, AstraZeneca, and RefleXion, unrelated to this research project. The other authors declare no competing interests. Publisher Copyright: © 2020 Elsevier Inc. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Purpose: The phase 2 randomized study SABR-COMET demonstrated that in patients with controlled primary tumors and 1 to 5 oligometastatic lesions, SABR was associated with improved progression-free survival (PFS) compared with standard of care (SoC), but with higher costs and treatment-related toxicities. The aim of this study was to assess the cost-effectiveness of SABR versus SoC in this setting. Methods and Materials: A Markov model was constructed to perform a cost-utility analysis from the Canadian health care system perspective. Utility values and transition probabilities were derived from individual-level data from the SABR-COMET trial. One-way, 2-way, and probabilistic sensitivity analyses were performed. Costs were expressed in 2018 CAD. A separate analysis based on US payer's perspective was performed. An incremental cost-effectiveness ratio (ICER) at a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was used. Results: In the base case scenario, SABR was cost-effective at an ICER of $37,157 per QALY gained. This finding was most sensitive to the number of metastatic lesions treated with SABR (ICER: $28,066 per QALY for 2, increasing to $64,429 per QALY for 5), difference in chemotherapy use (ICER: $27,173-$53,738 per QALY), and PFS hazard ratio (HR) between strategies (ICER: $31,548-$53,273 per QALY). Probabilistic sensitivity analysis revealed that SABR was cost-effective in 97% of all iterations. Two-way sensitivity analysis demonstrated a nonlinear relationship between the number of lesions and the PFS HR. To maintain cost-effectiveness for each additional metastasis, the HR must decrease by approximately 0.047. The US cost analysis yielded similar results, with an ICER of $54,564 (2018 USD per QALY) for SABR. Conclusions: SABR is cost-effective for patients with 1 to 5 oligometastatic lesions compared with SoC.
AB - Purpose: The phase 2 randomized study SABR-COMET demonstrated that in patients with controlled primary tumors and 1 to 5 oligometastatic lesions, SABR was associated with improved progression-free survival (PFS) compared with standard of care (SoC), but with higher costs and treatment-related toxicities. The aim of this study was to assess the cost-effectiveness of SABR versus SoC in this setting. Methods and Materials: A Markov model was constructed to perform a cost-utility analysis from the Canadian health care system perspective. Utility values and transition probabilities were derived from individual-level data from the SABR-COMET trial. One-way, 2-way, and probabilistic sensitivity analyses were performed. Costs were expressed in 2018 CAD. A separate analysis based on US payer's perspective was performed. An incremental cost-effectiveness ratio (ICER) at a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was used. Results: In the base case scenario, SABR was cost-effective at an ICER of $37,157 per QALY gained. This finding was most sensitive to the number of metastatic lesions treated with SABR (ICER: $28,066 per QALY for 2, increasing to $64,429 per QALY for 5), difference in chemotherapy use (ICER: $27,173-$53,738 per QALY), and PFS hazard ratio (HR) between strategies (ICER: $31,548-$53,273 per QALY). Probabilistic sensitivity analysis revealed that SABR was cost-effective in 97% of all iterations. Two-way sensitivity analysis demonstrated a nonlinear relationship between the number of lesions and the PFS HR. To maintain cost-effectiveness for each additional metastasis, the HR must decrease by approximately 0.047. The US cost analysis yielded similar results, with an ICER of $54,564 (2018 USD per QALY) for SABR. Conclusions: SABR is cost-effective for patients with 1 to 5 oligometastatic lesions compared with SoC.
UR - http://www.scopus.com/inward/record.url?scp=85099134732&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijrobp.2020.12.001
DO - https://doi.org/10.1016/j.ijrobp.2020.12.001
M3 - Article
C2 - 33309977
SN - 0360-3016
VL - 109
SP - 1176
EP - 1184
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -