Toxicity and cost-effectiveness analysis of intensity modulated radiation therapy versus 3-dimensional conformal radiation therapy for postoperative treatment of gynecologic cancers.
OBJECTIVE
To evaluate toxicity and cost-effectiveness of intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT) in the postoperative treatment of uterine and cervical cancer.


METHODS
Between 2000 and 2012, eighty patients at our institution received post-hysterectomy 3DCRT (46) or IMRT (34) for uterine or cervical cancer. Baseline characteristics, outcome, and ≥CTCAE grade 2 toxicities were compared between the two groups. Predictors of toxicity-free survival were identified. A decision analysis model was designed to capture individual health states at 1, 2, and 3 years after treatment. Micro-costing technique and estimated quality-adjusted life years (QALYs) were used to calculate incremental cost-effectiveness ratio (ICER).


RESULTS
Utilization of IMRT increased from 25% (2005-2007) to 75% (2008-2012). Recurrence-free and overall survival rates were not different between the two groups. Toxicity rates were reduced with IMRT versus 3DCRT (HR 0.42, p=0.04). Women who received IMRT had numerically lower rates of late gastrointestinal and genitourinary toxicity and significantly lower rates of late overall toxicity at 3 years (16% vs. 45%, p=0.04). On univariate analysis, IMRT was associated with decreased late toxicity (HR 0.43, p=0.04). Treatment costs were higher and toxicity costs were lower with IMRT. IMRT had an ICER of $235,233 (year 1), $114,270 (year 2), and $75,555 (year 3) per QALY gained.


CONCLUSION
IMRT is associated with reduced late overall toxicity compared to 3DCRT without compromising clinical outcome. IMRT is not cost-effective during the early chronic toxicity phase, but it becomes more cost-effective over time.
['Chen|L Andy|LA|', 'Kim|Jaewhan|J|', 'Boucher|Kenneth|K|', 'Terakedis|Breanne|B|', 'Williams|Britney|B|', 'Nickman|Nancy A|NA|', 'Gaffney|David K|DK|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D003362:Cost-Benefit Analysis D016208:Databases, Factual D003661:Decision Support Techniques D005260:Female D017721:Hospital Costs D006801:Humans D007044:Hysterectomy D008875:Middle Aged D011184:Postoperative Period D019057:Quality-Adjusted Life Years D018714:Radiotherapy, Adjuvant D020266:Radiotherapy, Conformal D050397:Radiotherapy, Intensity-Modulated D012042:Registries D012189:Retrospective Studies D016019:Survival Analysis D016896:Treatment Outcome D014589:Utah D002583:Uterine Cervical Neoplasms D014594:Uterine Neoplasms
Cost-benefit analysis Endometrial neoplasms Health care economics Radiotherapy, conformal Radiotherapy, intensity-modulated Uterine cervical neoplasms