Universität zu Köln

Arruda, Gustavo Viani, Lourencao, Marina, Caldeira de Oliveira, Jorge Henrique, Correa Galendi, Julia Simoes and Jacinto, Alexandre Arthur ORCID: 0000-0002-6353-2202 (2022). Cost-effectiveness of stereotactic body radiotherapy versus conventional radiotherapy for the treatment of surgically ineligible stage I non-small cell lung cancer in the Brazilian public health system. Lancet Regional Health-Americas, 14. AMSTERDAM: ELSEVIER. ISSN 2667-193X

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Abstract

Background The Brazilian public health system does not pay for the use of Stereotactic body radiotherapy (SBRT) due to its costs and the absence of cost-effectiveness analysis showing its benefit. The present study aims to evaluate whether the SBRT is a more cost-effective strategy than the conventional fractionated radiotherapy (CFRT) for surgically ineligible stage I non-small cell lung cancer (NSCLC) in the Brazilian public health system. Methods Adopting the perspective of the Brazilian Unified Healthcare System (SUS) as the payer, a Markov model with a lifetime horizon was built to delineate the health states for a cohort of 75-years-old men with medically inoperable NSCLC after treatment with SBRT or CFRT. Transition probabilities and health states utilities were adapted from the literature. Costs were based on the public health system reimbursement values and simulated in the private sector. Findings The SBRT strategy results in more quality-adjusted life-year (QALYs) and costs with an incremental cost-effectiveness ratio (ICER) of R$ 164.86 (U$ 65.16) per QALY and R$ 105 (U$ 41.50) per life-year gained (LYG). This strategy was cost-effective, considering a willingness-to-pay of R$ 25,000 (U$ 9,881.42) per QALY. The net monetary benefit (NMB) was approximately twice higher. The outcomes were confirmed with 92% of accuracy in the probabilistic sensitivity analysis. Interpretation Using a threshold of R$25,000 per QALY, SBRT was more cost-effective than CFRT for NSCLC in a public health system of an upper-middle-income country. SBRT generates higher NMB than CFRT, which could open the opportunity to incorporate new technologies. Copyright (c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Arruda, Gustavo Viani UNSPECIFIED UNSPECIFIED UNSPECIFIED Lourencao, Marina UNSPECIFIED UNSPECIFIED UNSPECIFIED Caldeira de Oliveira, Jorge Henrique UNSPECIFIED UNSPECIFIED UNSPECIFIED Correa Galendi, Julia Simoes UNSPECIFIED UNSPECIFIED UNSPECIFIED Jacinto, Alexandre Arthur UNSPECIFIED orcid.org/0000-0002-6353-2202 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-672212
DOI:	10.1016/j.lana.2022.100329
Journal or Publication Title:	Lancet Regional Health-Americas
Volume:	14
Date:	2022
Publisher:	ELSEVIER
Place of Publication:	AMSTERDAM
ISSN:	2667-193X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RADIATION-THERAPY; ABLATIVE RADIOTHERAPY; SBRT Multiple languages Health Care Sciences & Services; Public, Environmental & Occupational Health Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/67221