ESTRO 2022

Session Item

Saturday

May 07

09:00 - 10:00

Mini-Oral Theatre 2

02: Health economics & healthcare systems

Chair: , United Kingdom;

Co-Chair: Theresa O'Donovan, Ireland

Session Code: 1170

Session Type: Mini-Oral

Track: Interdisciplinary

Cost-effectiveness of hypofractionated radiotherapy in intermediate-risk prostate cancer.

Marion Renouf, France

Presentation Number: MO-0058

Abstract

Abstract Title:

Cost-effectiveness of hypofractionated radiotherapy in intermediate-risk prostate cancer.

Authors:

Marion Renouf¹, Ke Zhou², Genevieve Perrocheau², Nicolas Magné³, Guy De Brisson de la Roche³, Igor Latorzeff⁴, Pascal Pommier⁵, Gilles Créhange⁶, Amaury Paumier⁷, Guillaume Bera⁸, Charles Catton⁹, Martine Bellanger², Stéphane Supiot¹

¹Institut de Cancérologie de l'Ouest René Gauducheau, Radiation Oncology, Nantes, France; ²Institut de Cancérologie de l'Ouest René Gauducheau, Human and Social Sciences, Nantes, France; ³Institut de Cancérologie Lucien Neuwirth, Radiation Oncology, Saint Priest en Jarez, France; ⁴Clinique Pasteur, Radiation Oncology, Toulouse, France; ⁵Centre Léon Bérard, Radiation Oncology, Lyon, France; ⁶Institut Curie, Radiation Oncology, Paris, France; ⁷Institut de Cancérologie de l'Ouest Paul Papin, Radiation Oncology, Angers, France; ⁸Hôpital du Scorff, Groupe Hospitalier Bretagne Sud, Radiation Oncology, Lorient, France; ⁹Princess Margaret Hospital, University of Toronto, Radiation Oncology, Toronto, Canada

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Purpose or Objective

Hypofractionated Radiation therapy (RT) is considered a safe and efficient treatment option for localized prostate cancer. The international PROstate Fractionated Irradiation Trial (PROFIT) found moderate hypofractionation to be non-inferior to standard dose-escalated RT for intermediate-risk prostate cancer. The aim of this study is to evaluate the cost-effectiveness of moderate hypofractionation compared to conventional RT for treatment of intermediate-risk prostate cancer.

Material and Methods

A randomized prospective multicenter ancillary study of the PROFIT trial was conducted in France in six centers. Costs were determined from the National Health Insurance System (NHIS) reimbursement rates. We conducted a cost-effectiveness analysis from the NHIS payer’s perspective, with a time horizon of 48 months. To estimate total costs per patient, we assigned unit costs to resource use for transportation, medical exams, visits and inpatient stays for adverse events. Results from EPIC questionnaires at baseline, M24 and M48 were mapped to obtain EuroQol five-dimensional questionnaire (EQ-5D) equivalent to generate Quality Adjusted Life Years (QALY). Total costs were combined with QALY to estimate the Incremental Cost-effectiveness ratio (ICER) over the 48-month follow-up.

Results

Between December 8, 2011, and January 25, 2016, 231 patients were included: 116 received conventional fractionated RT and 106 had hypofractionated RT. Median follow-up was 5.4 years (4.4-6.3 years). Total costs per patient were higher in the conventional arm than in the short arm (€4,285 (95% CI: €3,355–€5,215) vs. €3,062 (95% CI: €2,368-€3,756), p<0.05), as shown in Table 1. This was mainly due to transportation costs (€2,944 vs. €1,754, p <0.01). QALY were significantly higher in the hypofractionated arm, with a difference of 0.037 (95% CI: 0.014 to 0.061).

Radiation therapy (RT)	Total Costs €,2020 (95%CI)	Incremental costs	QALY (95%CI)	Incremental QALY	Incremental costs/QALY
Conventional RT	4,285 (3,355-5,215)	-	3.288 (3.270 to 3.305)	-	-
Hypofractionated RT	3,062 (2,368-3,756)	- 1,223 (-2,373 to -73)	3.325 (3.307 to 3.342)	0.037 (0.014 to 0.061)	Hypofractionated RT dominant

Table 1. Total costs with incremental cost-effectiveness ratio per QALY in conventional and hypofractionated arms.

Conclusion

Treating localized prostate cancer with moderate Hypofractionated RT is cost saving and improves slightly quality of life. Adopting such a treatment with an updated reimbursement rate would result in a lower global expense for the NHIS in France.