Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1590/1806-9282.20210078 http://hdl.handle.net/11449/222598 |
Resumo: | OBJECTIVE: The intensity-modulated radiotherapy (IMRT) has been established as the standard external-beam radiation technique to treat prostate cancer in several countries. In Brazil, the public health system and the National Health Agency do not reimburse its utilization. This study compared the cost-effectiveness of IMRT and tridimensional radiotherapy (3D-RT) from a payer's perspective. METHODS: We built a Markov model to delineate the health states after treatment with IMRT and 3D-RT. The treatment-related toxicity data were extracted from the literature. The sensitivity analyses were performed over potential parameters. RESULTS: The incremental cost of IMRT was R$ 5,553.78. At a time horizon of 5 years, the quality-adjusted life expectancy after IMRT was higher than 3D-RT. The incremental cost-effectiveness ratio (ICER) of IMRT over 3D-RT was R$-296,74/quality-adjusted life year (QALY). Therefore, IMRT was the dominant strategy, which depended on the value of interventional procedures for severe toxicity and the difference between IMRT and 3D-RT reimbursement. The IMRT was still most likely to be cost-effective at a willingness-to-pay R$ 100,000/QALY, with a net monetary benefit (NMB) superior to 3D-RT after R$ 50,000.00, resulting in a difference of R$220.000,00 after 5 years. CONCLUSIONS: IMRT generated more values than 3D-RT for external-beam treatment. Given its potential to reduce late toxicity with hypofractionation, these data reinforce its incorporation to treat prostate cancer in the Brazilian health system from a payer's perspective. |
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Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health systemOBJECTIVE: The intensity-modulated radiotherapy (IMRT) has been established as the standard external-beam radiation technique to treat prostate cancer in several countries. In Brazil, the public health system and the National Health Agency do not reimburse its utilization. This study compared the cost-effectiveness of IMRT and tridimensional radiotherapy (3D-RT) from a payer's perspective. METHODS: We built a Markov model to delineate the health states after treatment with IMRT and 3D-RT. The treatment-related toxicity data were extracted from the literature. The sensitivity analyses were performed over potential parameters. RESULTS: The incremental cost of IMRT was R$ 5,553.78. At a time horizon of 5 years, the quality-adjusted life expectancy after IMRT was higher than 3D-RT. The incremental cost-effectiveness ratio (ICER) of IMRT over 3D-RT was R$-296,74/quality-adjusted life year (QALY). Therefore, IMRT was the dominant strategy, which depended on the value of interventional procedures for severe toxicity and the difference between IMRT and 3D-RT reimbursement. The IMRT was still most likely to be cost-effective at a willingness-to-pay R$ 100,000/QALY, with a net monetary benefit (NMB) superior to 3D-RT after R$ 50,000.00, resulting in a difference of R$220.000,00 after 5 years. CONCLUSIONS: IMRT generated more values than 3D-RT for external-beam treatment. Given its potential to reduce late toxicity with hypofractionation, these data reinforce its incorporation to treat prostate cancer in the Brazilian health system from a payer's perspective.Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - Ribeirão Preto (SP)Universidade de São Paulo (USP)Viani, Gustavo ArrudaArruda, Caio VianiOliveira, Rogerio2022-04-28T19:45:33Z2022-04-28T19:45:33Z2021-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article724-730http://dx.doi.org/10.1590/1806-9282.20210078Revista da Associacao Medica Brasileira (1992), v. 67, n. 5, p. 724-730, 2021.1806-9282http://hdl.handle.net/11449/22259810.1590/1806-9282.202100782-s2.0-85116739807Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengRevista da Associacao Medica Brasileira (1992)info:eu-repo/semantics/openAccess2022-04-28T19:45:33Zoai:repositorio.unesp.br:11449/222598Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-05T23:36:06.673209Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system |
title |
Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system |
spellingShingle |
Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system Viani, Gustavo Arruda |
title_short |
Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system |
title_full |
Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system |
title_fullStr |
Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system |
title_full_unstemmed |
Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system |
title_sort |
Cost-effectiveness analysis comparing intensity-modulated radiotherapy with conformational radiotherapy (3D-RT) for prostate cancer in the brazilian health system |
author |
Viani, Gustavo Arruda |
author_facet |
Viani, Gustavo Arruda Arruda, Caio Viani Oliveira, Rogerio |
author_role |
author |
author2 |
Arruda, Caio Viani Oliveira, Rogerio |
author2_role |
author author |
dc.contributor.none.fl_str_mv |
Universidade de São Paulo (USP) |
dc.contributor.author.fl_str_mv |
Viani, Gustavo Arruda Arruda, Caio Viani Oliveira, Rogerio |
description |
OBJECTIVE: The intensity-modulated radiotherapy (IMRT) has been established as the standard external-beam radiation technique to treat prostate cancer in several countries. In Brazil, the public health system and the National Health Agency do not reimburse its utilization. This study compared the cost-effectiveness of IMRT and tridimensional radiotherapy (3D-RT) from a payer's perspective. METHODS: We built a Markov model to delineate the health states after treatment with IMRT and 3D-RT. The treatment-related toxicity data were extracted from the literature. The sensitivity analyses were performed over potential parameters. RESULTS: The incremental cost of IMRT was R$ 5,553.78. At a time horizon of 5 years, the quality-adjusted life expectancy after IMRT was higher than 3D-RT. The incremental cost-effectiveness ratio (ICER) of IMRT over 3D-RT was R$-296,74/quality-adjusted life year (QALY). Therefore, IMRT was the dominant strategy, which depended on the value of interventional procedures for severe toxicity and the difference between IMRT and 3D-RT reimbursement. The IMRT was still most likely to be cost-effective at a willingness-to-pay R$ 100,000/QALY, with a net monetary benefit (NMB) superior to 3D-RT after R$ 50,000.00, resulting in a difference of R$220.000,00 after 5 years. CONCLUSIONS: IMRT generated more values than 3D-RT for external-beam treatment. Given its potential to reduce late toxicity with hypofractionation, these data reinforce its incorporation to treat prostate cancer in the Brazilian health system from a payer's perspective. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-06-01 2022-04-28T19:45:33Z 2022-04-28T19:45:33Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1590/1806-9282.20210078 Revista da Associacao Medica Brasileira (1992), v. 67, n. 5, p. 724-730, 2021. 1806-9282 http://hdl.handle.net/11449/222598 10.1590/1806-9282.20210078 2-s2.0-85116739807 |
url |
http://dx.doi.org/10.1590/1806-9282.20210078 http://hdl.handle.net/11449/222598 |
identifier_str_mv |
Revista da Associacao Medica Brasileira (1992), v. 67, n. 5, p. 724-730, 2021. 1806-9282 10.1590/1806-9282.20210078 2-s2.0-85116739807 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Revista da Associacao Medica Brasileira (1992) |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
724-730 |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
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1808129535367970816 |