Cost-effectiveness Analysis of Moderately Hypofractionated Radiation Therapy with Helical TomoTherapy Versus Conventional Radiation Therapy for Unresectable Stage III Non-small Cell Lung Cancer

Background Moderately Hypofractionated Radiation Therapy (Hypo-RT) has been considered as an alternative strategy for unresectable stage III non-small cell lung cancer (NSCLC) receiving concurrent chemotherapy, with potential benefits in overall survival and local control. In this study, we compared the cost-effectiveness of Hypo-RT with that of Con-RT in patients with unresectable stage III non-small cell lung cancer receiving concurrent chemotherapy. Objectives Both prospective and retrospective studies have demonstrated that, compared with Con-RT, Hypo-RT resulted in superior local control of the primary disease without an increase in major toxicity in patients with medically inoperable stage III NSCLC. However, to the best of our knowledge, the economic value of using this new therapy for this indication is currently unknown. Therefore, our study aimed to evaluate the cost-effectiveness of Hypo-RT for the standard-of-care treatment of medically inoperable, early-stage NSCLC. Methods A three-stage Markov model over a 5-year lifetime horizon was developed to compare the cost and effectiveness of Hypo-RT with that of Con-RT. The primary outcomes of our study included life years (LYs) total cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the results. Results In the base case analysis, the cost and QALYs of Hypo-RT were $123,721.28 and 2.23, while for Con-RT, the cost and QALYs were $187,803.55 and 1.69, respectively. Hypo-RT is a more cost-effective strategy compared with Con-RT for medically inoperable stage III NSCLC, with $118,848.20 is saved for every incremental QALY. This result was validated by DSA and PSA, in which SBRT remained the most cost-effective option. Hypo-RT was dominant compared to Con-RT, and Hypo-RT was the most cost-effective option. Conclusions Hypo-RT is likely to be a cost-effective option compared with Con-RT for patients with unresectable stage III non-small cell lung cancer receiving concurrent chemotherapy.