Cost Effectiveness of Modified Fractionation Radiotherapy versus Conventional Radiotherapy for Unresected Non-Small-Cell Lung Cancer Patients

Introduction: Modified fractionation radiotherapy (RT), delivering multiple fractions per day or shortening the overall treatment time, improves overall survival for non -small-cell lung cancer (NSCLC) patients compared with conventional fractionation RT (CRT). However, its cost effectiveness is unknown. Therefore, we aimed to examine and compare the cost effectiveness of different modified RT schemes and CRT in the curative treatment of unresected NSCLC patients. Methods: A probabilistic Markov model was developed based on individual patient data from the meta-analysis of radiotherapy in lung cancer (N = 2000). Dutch health care costs, quality-adjusted life years (QALYs), and net monetary benefits (NMBs) were compared between two accelerated schemes (very accelerated RT [VART] and moderately accelerated RT [MART]), two hyperfractionated schemes (using an identical (HRTI) or higher (HRTH) total treatment dose than CRT) and CRT. Results: All modified fractionations were more effective and costlier than CRT (1.12 QALYs, Euro24,360). VART and MART were most effective (1.30 and 1.32 QALYs) and cost Euro25,746 and Euro26,208, respectively. HRTI and HRTH yielded less QALYs than the accelerated schemes (1.27 and 1.14 QALYs), and cost Euro26,199 and Euro29,683, respectively. MART had the highest NMB (Euro79,322; 95% confidence interval [CI], Euro35,478-Euro133,648) and was the most cost-effective treatment followed by VART (Euro78,347; 95% CI, Euro64,635-Euro92,526). CRT had an NMB of Euro65,125 (95% CI, Euro54,663-Euro75,537). MART had the highest probability of being cost effective (43%), followed by VART (31%), HRTI (24%), HRTH (2%), and CRT (0%). Conclusion: Implementing accelerated RT is almost certainly more efficient than current practice CRT and should be recommended as standard RT for the curative treatment of unresected NSCLC patients not receiving concurrent chemo-radiotherapy.