Universität zu Köln

Galendi, Julia Simoes Correa, Yeo, Sin Yuin, Grull, Holger, Bratke, Grischa, Akuamoa-Boateng, Dennis, Baues, Christian, Bos, Clemens, Verkooijen, Helena M., Shukri, Arim, Stock, Stephanie and Muller, Dirk (2022). Early economic modeling of magnetic resonance image-guided high intensity focused ultrasound compared to radiotherapy for pain palliation of bone metastases. Front. Oncol., 12. LAUSANNE: FRONTIERS MEDIA SA. ISSN 2234-943X

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Abstract

IntroductionMagnetic Resonance Image-guided High Intensity Focused Ultrasound (MR-HIFU) is a non-invasive treatment option for palliative patients with painful bone metastases. Early evidence suggests that MR-HIFU is associated with similar overall treatment response, but more rapid pain palliation compared to external beam radiotherapy (EBRT). This modelling study aimed to assess the cost-effectiveness of MR-HIFU as an alternative treatment option for painful bone metastases from the perspective of the German Statutory Health Insurance (SHI). Materials and methodsA microsimulation model with lifelong time horizon and one-month cycle length was developed. To calculate the incremental cost-effectiveness ratio (ICER), strategy A (MR-HIFU as first-line treatment or as retreatment option in case of persistent pain or only partial pain relief after EBRT) was compared to strategy B (EBRT alone) for patients with bone metastases due to breast, prostate, or lung cancer. Input parameters used for the model were extracted from the literature. Results were expressed as EUR per quality-adjusted life years (QALYs) and EUR per pain response (i.e., months spent with complete or partial pain response). Deterministic and probabilistic sensitivity analyses (PSA) were performed to test the robustness of results, and a value of information analysis was conducted. ResultsCompared to strategy B, strategy A resulted in additional costs (EUR 399) and benefits (0.02 QALYs and 0.95 months with pain response). In the base case, the resulting ICERs (strategy A vs. strategy B) are EUR 19,845/QALY and EUR 421 per pain response. Offering all patients MR-HIFU as first-line treatment would increase the ICER by 50% (31,048 EUR/QALY). PSA showed that at a (hypothetical) willingness to pay of EUR 20,000/QALY, the probability of MR-HIFU being cost-effective was 52%. The expected value of perfect information (EVPI) for the benefit population in Germany is approximately EUR 190 Mio. ConclusionAlthough there is considerable uncertainty, the results demonstrate that introducing MR-HIFU as a treatment alternative for painful bone metastases might be cost-effective for the German SHI. The high EVPI indicate that further studies to reduce uncertainty would be worthwhile.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Galendi, Julia Simoes Correa UNSPECIFIED UNSPECIFIED UNSPECIFIED Yeo, Sin Yuin UNSPECIFIED UNSPECIFIED UNSPECIFIED Grull, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED Bratke, Grischa UNSPECIFIED UNSPECIFIED UNSPECIFIED Akuamoa-Boateng, Dennis UNSPECIFIED UNSPECIFIED UNSPECIFIED Baues, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Bos, Clemens UNSPECIFIED UNSPECIFIED UNSPECIFIED Verkooijen, Helena M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Shukri, Arim UNSPECIFIED UNSPECIFIED UNSPECIFIED Stock, Stephanie UNSPECIFIED UNSPECIFIED UNSPECIFIED Muller, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-674516
DOI:	10.3389/fonc.2022.987546
Journal or Publication Title:	Front. Oncol.
Volume:	12
Date:	2022
Publisher:	FRONTIERS MEDIA SA
Place of Publication:	LAUSANNE
ISSN:	2234-943X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language SINGLE FRACTION RADIOTHERAPY; SKELETAL-RELATED EVENTS; RADIATION-THERAPY; COST-EFFECTIVENESS; HEALTH TECHNOLOGIES; PROMISES; UPDATE; CANCER Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/67451