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The cost-effectiveness of surgical resection and cesium-131 intraoperative brachytherapy versus surgical resection and stereotactic radiosurgery in the treatment of metastatic brain tumors.

TitleThe cost-effectiveness of surgical resection and cesium-131 intraoperative brachytherapy versus surgical resection and stereotactic radiosurgery in the treatment of metastatic brain tumors.
Publication TypeJournal Article
Year of Publication2016
AuthorsA Wernicke G, Yondorf MZ, Parashar B, Nori D, Chao KSClifford, Boockvar JA, Pannullo S, Stieg P, Schwartz TH
JournalJ Neurooncol
Volume127
Issue1
Pagination145-53
Date Published2016 Mar
ISSN1573-7373
KeywordsAdult, Aged, Aged, 80 and over, Brachytherapy, Brain Neoplasms, Cesium Radioisotopes, Combined Modality Therapy, Cost-Benefit Analysis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Staging, Prognosis, Quality-Adjusted Life Years, Radiosurgery, Retrospective Studies, Survival Rate
Abstract

This study aims to evaluate the cost-effectiveness of surgical resection (S) and Cesium-131 (Cs-131) [S + Cs-131] intraoperative brachytherapy versus S and stereotactic radiosurgery (SRS) [S + SRS] for the treatment of brain metastases. Treatment records as well as hospital and outpatient charts of 49 patients with brain metastases between 2008 and 2012 who underwent S + Cs-131 (n = 24) and S + SRS (n = 25) were retrospectively reviewed. Hospital charges were compared for the single treatment in question. Means and curves of survival time were defined by the Kaplan-Meier estimator, with the cost analysis focusing on the time period of the relevant treatment. Quality adjusted life years (QALY) and Incremental cost-effectiveness ratios (ICER) were calculated for each treatment option as a measure of cost-effectiveness. The direct hospital costs of treatments per patient were: S + Cs131 = $19,271 and S + SRS = $44,219. The median survival times of S + Cs-131 and S + SRS were 15.5 and 11.3 months, and the 12 month survival rates were 61 % and 49 % (P = 0.137). The QALY for S + SRS when compared to S + Cs-131 yielded a p < 0.0001, making it significantly more cost-effective. The ICER also revealed that when compared to S + Cs-131, S + SRS was significantly inferior (p < 0.0001). S + Cs-131 is more cost-effective compared with S + SRS based on hospital charges as well as QALYs and ICER. Cost effectiveness, in addition to efficacy and risk, should factor into the comparison between these two treatment modalities for patients with surgically resectable brain metastases.

DOI10.1007/s11060-015-2026-4
Alternate JournalJ Neurooncol
PubMed ID26725100
Grant ListUL1-TR000457 / TR / NCATS NIH HHS / United States