Stereotactic body radiotherapy (SBRT) with a robotic system is currently more cost-effective than standard regimens as well as SBRT delivered with other systems for the treatment of prostate cancer, according to a recent study.
External beam therapy is a common treatment approach for patients with prostate cancer, but significant advances in the application of this technique have rapidly changed how physicians make decisions about radiation delivery. High-dose regimens were typically the standard of care, consisting of 78 Gy delivered in 39 fractions over the course of 8 weeks. However, further study has suggested that hypofractionated regimens (5 to 20 fractions delivered over 2 to 4 weeks) could better control tumor growth compared with standard regimens. Some studies have found that robotic systems for delivering SBRT can improve outcomes for patients, leading to growing interest in the study of high precision techniques for the delivery of ultra-hypofractionated (5 fractions) regimens.
Despite the promise of these systems, they can be expensive and take a substantial amount of time (60 minutes) to complete treatment delivery. In comparison, arc-based and fixed-gantry tactics can deliver treatments much more quickly. Less data on outcomes and costs associated with their use in practical settings are availably, however.
Therefore, researchers led by Waseem Sharieff, MD, Juravinski Cancer Centre (Ontario, Canada), performed an economic evaluation of SBRT with a robotic system compared with SBRT delivered through arc-based and fixed-gantry systems. The robotic system was also compared with standard therapy delivered through arc-based and fixed gantry systems.
Researchers examined a cohort of 5000 male patients with low-risk prostate cancer between 60 and 80 years of age. Hypofractionated regimens were: (1) 36.25 Gy, 5 fractions with 7.25 Gy per fraction; (2) 51.6 Gy, 12 fractions with 4.3 Gy per fraction; and (3) 60 Gy, 20 fractions with 3 Gy per fraction. The standard regimen was 78 Gy, 39 fractions with 2 Gy per fraction.
The primary outcome measures for the study were cost per patient, cost per cure, and cost per quality-adjusted life year (QALY). Cure data were taken from other studies, and cure was defined in terms of biochemical evidence of disease after treatment. Because no data have suggested one method to be better than another in terms of toxicity, that outcome measure was excluded from the study.
Costs for SBRT differed greatly depending on the delivery method, ranging from $4368 per patient (arc-based) to $6333 per patient (robotic) for 5 fractions; $4489 per patient (arc-based) to $5664 per patient (fixed-gantry) for 12 fractions; and $4956 per patient (arc-based) to $6462 per patient (fixed-gantry) for 20 fractions. Costs per patient associated with the standard regimen were higher than for SBRT, ranging from $5935 (arc-based) to $7992 (fixed-gantry). Results for cost per cure and cost per QALY were similar, with robotic SBRT showing superiority to other delivery methods as well as standard care.
Although the arc-based method initially seemed favorable, after further analysis, researchers determined that robotic SBRT was more cost-effective than the standard arc-based and fixed-gantry systems for delivering SBRT after cost per cure and cost per QALY were considered. However, if studies can show that SBRT can be delivered with at least equal efficacy and safety through an arc-based system, then this would be a more cost-effective option than robotic SBRT.
Despite these results, the authors suggested that decision-makers carefully consider whether their patient volume warrants the purchase of a robotic system if one is not already in place, due to the high cost of implementation.—Sean McGuire
