Cost-benefit analysis: Combo treatment costs more, saves money later
From a health insurer's perspective, the most effective cancer treatment may also be the most cost-effective, according to a new study sponsored by the Radiation Therapy Oncology Group (RTOG 91-11).
Compared to higher-priced combination treatments, the least expensive, single-modality cancer treatment may cost more in the long run because of the costs associated with treating complications and recurrence of cancer, said lead author Andre A. Konski, M.D., M.B.A., M.A., a radiation oncologist and director of clinical research in Fox Chase Cancer Center's radiation oncology department. Konski presented the results today at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Philadelphia.
The study examined costs for patients with Medicare insurance who had taken part in an RTOG clinical trial, #9111, for locally advanced laryngeal cancer between 1991 and 1996. That randomized phase III trial was designed to compare three treatment regimens--two combining radiation therapy and chemotherapy and one using only radiation therapy.
"In overall survival rates, there was no significant difference among the three treatment arms," Konski pointed out. "However, patients receiving induction chemotherapy as well as radiation or concurrent chemo-radiation therapy had better outcomes in terms of disease-free survival, local and regional control and preservation of their larynx.
"In our subsequent economic analysis," Konski explained, "these better outcomes translated into significant savings of dollars that were spent on treating patients for complications and recurrences that occurred with the less effective therapy of radiation by itself."
The specific aim of the new RTOG cost-benefit analysis was to evaluate the cost-effectiveness of the combination chemotherapy and radiation treatments compared to radiation therapy alone as viewed from the payer's perspective. Of the 547 patients who took part in RTOG 9111, Medicare cost data and clinical outcomes for 47 months were available for 66 patients.
Data included Medicare Part A and Part B costs from all providers--inpatient, outpatient, skilled nursing facility, home health care, hospice and physicians. The RTOG researchers calculated expected costs for the 47-month period for each arm of the trial, based on average estimates of survival probabilities and mean monthly costs for each month.
Incremental cost-effectiveness ratios were calculated as savings per life year in terms of overall survival and in terms of disease-free life years. Calculations were in 1996 dollars with the standard annual discount rate of 3 percent.
"Although radiation alone costs less in and of itself, the expected mean 47-month cost of that treatment was $57,357--compared to the two treatment arms that included chemotherapy," Konski said. "Concurrent chemo-radiation cost a little more $57,870, and represented an incremental increase of $697 per life year of overall survival and $2,048 per disease-free life year."
"Induction chemotherapy plus radiation therapy was the most cost-effective," Konski concluded. "At a 47-month cost of $49,018, this treatment saved $7,031 per disease free and $9336 per life year of total survival."
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