1217 - Modified fractionation radiotherapy versus conventional radiotherapy for unresected non-small cell lung cancer patients: a cost-effectiveness analysis

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Bioethics, Legal, and Economic Issues
Surgical Oncology
Non-Small Cell Lung Cancer
Radiation Oncology
Presenter Dirk De Ruysscher
Authors D. De Ruysscher1, B. Ramaekers2, M.A. Joore3, B. Lueza4, J. Bonastre4, A. Mauguen4, J. Pignon4, C. Le Pechoux5, J.P. Grutters6, ,. On Behalf Of The Mar-Lc Collaborative Group4
  • 1Radiation Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht/NL
  • 2Maastricht University, Maastricht/NL
  • 3Clinical Epidemiology And Medical Technology Assessment (kemta), Maastricht University, Maastricht/NL
  • 4Biostatistics And Epidemiology, Institut de Cancérologie Gustave-Roussy, Villejuif/FR
  • 5Medical Oncology, Institut Gustave Roussy, 94805 - VILLEJUIF/FR
  • 6Department Of Health Services Research (hsr), Caphri - School For Public Health And Primary Care, Maastricht University, Maastricht/NL



Modified fractionation radiotherapy (RT), delivering multiple fractions per day or shortening the overall treatment time, improves overall survival for non-small cell lung cancer (NSCLC) patients over conventional fractionation RT (CRT). However, its cost-effectiveness is unknown. Objective: To examine and compare the cost-effectiveness of different modified RT schemes and CRT in the curative treatment of unresected NSCLC patients.


A probabilistic Markov model was developed based on individual patient data from the Meta-Analysis of Radiotherapy in Lung Cancer (MAR-LC) with 10 randomized trials (N = 2000). Costs (Dutch healthcare perspective), quality-adjusted life years (QALYs) and net monetary benefits (NMB) were compared between 2 accelerated RT schemes (very accelerated (VART) and moderately accelerated (MART)), 2 hyperfractionated RT schemes (using an identical total treatment dose as CRT (HRTI) and higher total treatment dose as CRT (HRTH)) and CRT. The NMB was calculated by multiplying the number of QALYs by the ceiling ratio (what society is willing to pay per QALY) of €80,000 per QALY and subtracting the total costs. The treatment strategy with the highest NMB can be considered as the most cost-effective treatment.


All modified fractionations were more effective and costly than CRT (1.179 QALYs, €24,341). VART and MART were most effective (1.360 and 1.383 QALYs) and costed €25,735 and €26,194 respectively. HRTI and HRTH yielded less QALYs than the accelerated schemes (1.327 and 1.202 QALYs), and costed €26,187 and €29,688 respectively. MART had the highest NMB (€84,427; 95%CI €41,708-€139,698) and was thus the most cost-effective treatment followed by VART (€83,071; CI €69,785-€97,619). CRT had the second lowest NMB (€69,997; CI €59,684-€80,786). Uncertainty was considerable: MART had the highest probability of being cost-effective (43%), followed by VART (31%), HRTI (24%), HRTH (2%) and finally CRT (0%).


Implementing accelerated RT is almost certainly more efficient than current practice (CRT) and should be recommended as standard RT for the curative treatment of unresected NSCLC patients.


J. Pignon: Unrestricted grants from Roche for a meta-analysis of bevacizumab in advanced NSCLC.

All other authors have declared no conflicts of interest.