An Economic Analysis of Radiation Therapy Oncology Group 94-10: Cost-Efficacy of Concurrent vs. Sequential Chemoradiotherapy.

• Type of Material: Article
• Authors: Andre Konski, University of Pennsylvania; Mytheryi Bhargavan, American College of Radiology; Jean Owen, Radiation Therapy Oncology Group; Ritsuko Komaki, University of Texas MD Anderson Cancer Center; Corey J. Langer, University of Pennsylvania; Elizabeth Gore, Medical College of Wisconsin; Rebecca Paulus, Radiation Therapy Oncology Group; Hak Choy, University of Texas Southwestern Medical Center; Deborah Bruner, Emory University; Walter Curran, Emory University
• Language: English
• Date: 2018-06
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Springer-Verlag GmbH Germany, part of Springer Nature 2018
• Final Published Version (URL): http://dx.doi.org/10.1007/s13566-018-0346-7
• Title of Journal or Parent Work: Journal of Radiation Oncology
• ISSN: 1948-7894
• Volume: 7
• Issue: 2
• Start Page: 195
• End Page: 201
• Grant/Funding Information: This work was supported by the Pennsylvania Commonwealth Universal Research Enhancement (C.U.R.E.) Program ME-02-149 grant.; This trial was conducted by the Radiation Therapy Oncology Group (RTOG), and was supported by RTOG grant U10 CA21661; and CCOP grant U10 CA37422 from the National Cancer Institute (NCI).
• Keywords: Lung Cancer; Cost-effectiveness; Medicare dat; Induction chemotherapy; Combination chemotherapy
• Research Categories: Physics, Radiation; Health Sciences, Oncology; Health Sciences, Radiology

Abstract

Background: Cost can be a major issue in therapeutic decision-making, and in particular for patients with locally advanced non-small cell lung cancer (LA-NSCLC). Methods: The specific aim of this analysis was to evaluate the costs and outcomes of patients treated on Radiation Therapy Oncology Group (RTOG) 94-10, Medicare Part A and Part B costs from all for patients treated from 1991 to 1996 on RTOG 94-10, a phase III trial showing a survival benefit for concurrent chemoradiation (STD RT) over sequential (RT day 50) chemoradiation in LA-NSCLC with intermediate outcome for concurrent twice daily radiation and chemotherapy (HFX RT). 26-month expected costs for each arm of the trial in 1996 dollars were determined, with Kaplan Meier sampling average estimates of survival probabilities for each month and mean monthly costs. The analysis was performed from a payer's perspective. Incremental cost-effectiveness ratios were calculated comparing RT on day 50 and HFX RT to the STD RT. Results: Of the 610 patients entered, Medicare cost data and clinical outcomes were available for 92 patients. In this subset, compared to STD RT, RT on day 50 proved less costly but resulted in reduced survival at 1 year. In addition, HFX RT cost slightly more than STD RT but was less effective in this cohort of patients. Conclusions: In patients with Medicare insurance and with significant toxicity burden, RT on day 50 is the least expensive but also least effective treatment in this subset of patients treated on RTOG 94-10.