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Cost-effectiveness of treating head and neck cancer using intensity-modulated radiation therapy: implications for cancer control program in India

Published online by Cambridge University Press:  23 September 2020

Akashdeep Singh Chauhan ,
Shankar Prinja Open the ORCID record for Shankar Prinja [Opens in a new window] ,
Sushmita Ghoshal  and
Roshan Verma
Akashdeep Singh Chauhan
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Shankar Prinja
Affiliation:
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Sushmita Ghoshal
Affiliation:
Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Roshan Verma
Affiliation:
Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Background

The newer cancer treatment technologies hold the potential of providing improved health outcomes at an additional cost. So it becomes obligatory to assess the costs and benefits of a new technology, before defining its clinical value. We assessed the cost-effectiveness of intensity-modulated radiotherapy (IMRT) as compared to 2-dimensional radiotherapy (2-DRT) and 3-dimensional radiotherapy (3D-CRT) for treating head and neck cancers (HNC) in India. The cost-effectiveness of 3-DCRT as compared to 2-DRT was also estimated.

Methods

A probabilistic Markov model was designed. Using a disaggregated societal perspective, lifetime study horizon and 3 percent discount rate, future costs and health outcomes were compared for a cohort of 1000 patients treated with any of the three radiation techniques. Data on health system cost, out of pocket expenditure, and quality of life was assessed through primary data collected from a large tertiary care public sector hospital in India. Data on xerostomia rates following each of the radiation techniques was extracted from the existing randomized controlled trials.

Results

IMRT incurs an incremental cost of $7,072 (2,932–13,258) and $5,164 (463–10,954) per quality-adjusted life year (QALY) gained compared to 2-DRT and 3D-CRT, respectively. Further, 3D-CRT as compared to 2-DRT requires an incremental cost of $8,946 (1,996–19,313) per QALY gained.

Conclusion

Both IMRT and 3D-CRT are not cost-effective at 1 times GDP per capita for treating HNC in India. The costs and benefits of using IMRT for other potential indications (e.g. prostate, lung) require to be assessed before considering its introduction in India.

Keywords

Cost-effectiveness analysisIntensity-modulated radiation therapy3-Dimensional conformal radiotherapy2-Dimensional radiotherapyHead and neck cancers
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 36 , Issue 5 , October 2020 , pp. 492 - 499
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Guadagnolo, BA, Liu, CC, Cormier, JN, Du, XL. Evaluation of trends in the use of intensity-modulated radiotherapy for head and neck cancer from 2000 through 2005: Socioeconomic disparity and geographic variation in a large population-based cohort. Cancer. 2010;116:3505–12.10.1002/cncr.25205CrossRefGoogle Scholar
Van Dyk, J. The modern technology of radiation oncology. Madison, Wisconsin: Medical Physics Publishing; 1999.Google Scholar
Ezzell, GA, Galvin, JM, Low, D, Palta, JR, Rosen, I, Sharpe, MB, et al. Guidance document on delivery, treatment planning, and clinical implementation of IMRT: Report of the IMRT Subcommittee of the AAPM Radiation Therapy Committee. Med Phys. 2008;30:2089–115.CrossRefGoogle Scholar
Webb, S. The physical basis of IMRT and inverse planning. Br J Radiol. 2003;76:678–89.10.1259/bjr/65676879CrossRefGoogle ScholarPubMed
Ferlay, J, Soerjomataram, I, Dikshit, R, Eser, S, Mathers, C, Rebelo, M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.CrossRefGoogle ScholarPubMed
Tribius, S, Bergelt, C. Intensity-modulated radiotherapy versus conventional and 3D conformal radiotherapy in patients with head and neck cancer: Is there a worthwhile quality of life gain? Cancer Treat Rev. 2011;37:511–19.10.1016/j.ctrv.2011.01.004CrossRefGoogle Scholar
Kouloulias, V, Thalassinou, S, Platoni, K, Zygogianni, A, Kouvaris, J, Antypas, C, et al. The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters. Biomed Res Int. 2013;2013:401261.10.1155/2013/401261CrossRefGoogle ScholarPubMed
Marta, GN, Silva, V, de Andrade Carvalho, H, de Arruda, FF, Hanna, SA, Gadia, R, et al. Intensity-modulated radiation therapy for head and neck cancer: Systematic review and meta-analysis. Radiother Oncol. 2014;110:9–15.CrossRefGoogle ScholarPubMed
Sheets, NC, Wheeler, SB, Kohler, RE, Fried, DV, Brown, PM, Chera, BSl. Costs of care in a matched pair comparison of intensity-modulated radiation therapy (IMRT) versus conventional radiation therapy (CRT) for the treatment of head and neck cancer. Am J Clin Oncol. 2014;37:539–44.10.1097/COC.0b013e318282a850CrossRefGoogle Scholar
Chauhan, AS, Prinja, S, Ghoshal, S, Verma, R, Oinam, AS. Cost of treatment for head and neck cancer in India. PLoS ONE. 2018;13:e0191132.CrossRefGoogle ScholarPubMed
Department of Health Research, Ministry of Health and Family Welfare, Government of India. Health technology assessment in India: A manual. New Delhi: Department of Health Research; 2018.Google Scholar
Drummond, MF, O'Brien, BJ, Stoddard, GL, Torrance, GW. Methods for the economic evaluation of health care programmes. 2nd edn. New York: Oxford University Press; 1987.Google Scholar
Tan-Torres Edejer, T, Baltussen, R, Adam, T. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization; 2003.Google Scholar
Nutting, CM, Morden, JP, Harrington, KJ, Urbano, TG, Bhide, SA, Clark, C, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): A phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12:127–36.CrossRefGoogle ScholarPubMed
Ghosh-Laskar, S, Yathiraj, PH, Dutta, D, Rangarajan, V, Purandare, N, Gupta, T, et al. Prospective randomized controlled trial to compare 3-dimensional conformal radiotherapy to intensity-modulated radiotherapy in head and neck squamous cell carcinoma: Long-term results. Head Neck. 2016;38:E1481–7.10.1002/hed.24263CrossRefGoogle ScholarPubMed
Schoenfeld, GO, Amdur, RJ, Morris, CG, Li, JG, Hinerman, RW, Mendenhall, WM. Patterns of failure and toxicity after intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2008;71:377–85.10.1016/j.ijrobp.2007.10.010CrossRefGoogle ScholarPubMed
Eisbruch, A, Harris, J, Garden, AS, Chao, CK, Straube, W, Harari, PM, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for earlystage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys. 2010;76:1333–8.10.1016/j.ijrobp.2009.04.011CrossRefGoogle Scholar
Peng, G, Wang, T, Yang, KY, Zhang, S, Zhang, T, Li, Q, et al. A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs. conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma. Radiother Oncol. 2012;104:286–93.CrossRefGoogle ScholarPubMed
Tang, LL, Chen, L, Mao, YP, Li, WF, Sun, Y, Liu, LZ, et al. Comparison of the treatment outcomes of intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in nasopharyngeal carcinoma patients with parapharyngeal space extension. Radiother Oncol. 2015;116:167–73.10.1016/j.radonc.2015.07.038CrossRefGoogle ScholarPubMed
OuYang, PY, Shi, D, Sun, R, Zhu, YJ, Xiao, Y, Zhang, LN, et al. Effect of intensity-modulated radiotherapy versus two-dimensional conventional radiotherapy alone in nasopharyngeal carcinoma. Oncotarget. 2016;7:33408–17.10.18632/oncotarget.8573CrossRefGoogle ScholarPubMed
Krishnatreya, M, Rahman, T, Kataki, AC, Sharma, JD, Nandy, P, Baishya, N. Pre treatment performance status and stage at diagnosis in patients with head and neck cancers. Asian Pac J Cancer Prev. 2014;15:8479–82.10.7314/APJCP.2014.15.19.8479CrossRefGoogle ScholarPubMed
Prakash Saxena, PU, Unnikrishnan, B, Rathi, P, Kotian, H, Reshmi, B. Survival analysis of head and neck cancer: Results from a hospital based cancer registry in southern Karnataka. Clinical Epidemiology and Global Health. 2019;7:346–50.10.1016/j.cegh.2018.08.007CrossRefGoogle Scholar
Chauhan, AS, Prinja, S, Ghoshal, S, Verma, R. Economic burden of head and neck cancer treatment in North India. Asian Pac J Cancer Prev. 2019;20:403–9.CrossRefGoogle ScholarPubMed
Singh, M, Prasad, CP, Singh, TD, Kumar, L. Cancer research in India: Challenges & opportunities. Indian J Med Res. 2018;148:362–5.Google ScholarPubMed
Gupta, T, Agarwal, J, Jain, S, Phurailatpam, R, Kannan, S, Ghosh-Laskar, S, et al. Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: A randomized controlled trial. Radiother Oncol. 2012;104:343–8.CrossRefGoogle ScholarPubMed
Nandakumar, A, Rath, GK, Kataki, AC, Bapsy, PP, Gupta, PC, Gangadharan, P, et al. Survival in head and neck cancers – results of a multi-institution study. Asian Pac J Cancer Prev. 2016;17:1745–54.CrossRefGoogle ScholarPubMed
EuroQol Group. Euroqol – A new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy. 1990;16:199–208.CrossRefGoogle Scholar
Cox, JD, Stetz, J, Pajak, TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6.10.1016/0360-3016(95)00060-CCrossRefGoogle Scholar
Tongsiri, S, Cairns, J. Estimating population-based values for EQ-5D health states in Thailand. Value in Health. 2011;14:1142–5. pmid:22152185.10.1016/j.jval.2011.06.005CrossRefGoogle ScholarPubMed
Bahuguna, P, Prinja, S, Lahariya, C, Dhiman, RK, Kumar, MP, Sharma, V, et al. Cost-effectiveness of therapeutic use of safety-engineered syringes in healthcare facilities in India. Appl Health Econ Health Policy. 2020;18:393–411.CrossRefGoogle ScholarPubMed
Chauhan, AS, Prinja, S, Srinivasan, R, Rai, B, Malliga, JS, Gupta, N, Ghoshal, S Cost Effectiveness of Strategies for Cervical Cancer Prevention in India. PLoS One. 2020;15(9):e0238291.CrossRefGoogle ScholarPubMed
Chugh, Y, Dhiman, RK, Premkumar, M, Prinja, S, Singh Grover, G, Bahuguna, P. Real-world cost-effectiveness of pan-genotypic Sofosbuvir-Velpatasvir combination versus genotype dependent directly acting anti-viral drugs for treatment of hepatitis C patients in the universal coverage scheme of Punjab state in India. PLoS ONE. 2019;14:e0221769.CrossRefGoogle ScholarPubMed
Chapko, MK, Liu, CF, Perkins, M, Li, YF, Fortney, JC, Maciejewski, ML. Equivalence of two healthcare costing methods: Bottom-up and top-down. Health Econ. 2009;18:1181–201.CrossRefGoogle ScholarPubMed
Doubilet, P, Begg, CB, Weinstein, MC, Braun, P, McNeil, BJ. Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Making. 1985;5:157–77.10.1177/0272989X8500500205CrossRefGoogle ScholarPubMed
Baskar, R, Lee, KA, Yeo, R, Yeoh, K-W. Cancer and radiation therapy: Current advances and future directions. Int J Med Sci. 2012;9:193–9.CrossRefGoogle ScholarPubMed
Arruebo, M, Vilaboa, N, Sáez-Gutierrez, B, Lambea, J, Tres, A, Valladares, M, et al. Assessment of the evolution of cancer treatment therapies. Cancers. 2011;3:3279–330.10.3390/cancers3033279CrossRefGoogle ScholarPubMed
D'Cruz, AK, Chaukar, D, Gupta, T. Evidence based management of guidelines in India. Guidelines for head and neck cancer (part A). Mumbai: Tata Memorial Centre; 2012.Google Scholar
Krishnatreya, M, Kataki, AC, Sharma, JD, Baishya, N, Rahman, T, Bhattcharyya, M, et al. A survival analysis of hypopharyngeal cancer patients: A hospital-cancer registry based study. Indian J Otolaryngol Head Neck Surg. 2019;71:798–804.CrossRefGoogle ScholarPubMed
Dimri, K, Pandey, AK, Trehan, R, Rai, B, Kumar, A. Conventional radiotherapy with concurrent weekly cisplatin in locally advanced head and neck cancers of squamous cell origin – a single institution experience. Asian Pac J Cancer Prev. 2013;14:6883–88.CrossRefGoogle ScholarPubMed
Government of India, Ministry of Health and Family Welfare, Department of Health and Family Welfare, National Cancer Control Programme. Available from: http://mohfw.nic.in/about-us/departments/departments-health-and-family-welfare/national-cancer-control-programme. (Assessed February 20, 2017).Google Scholar
National Cancer Grid. Collaboration for Cancer Care. Available from: https://tmc.gov.in/ncg/.Google Scholar
International Atomic Energy Agency (IAEA), Directory of radiotherapy centres. Available from: https://dirac.iaea.org/.Google Scholar
International Atomic Energy Agency. Availability of radiotherapy. Number of radiotherapy machine per million persons. Available from: http://www.iaea.org/newscenter/focus/cancercare/dirac2012.pdf 2012.Google Scholar
World Health Organization. Core programme clusters – non-communicable diseases & mental health (NMH). New Delhi: Ministry of Health & Family Welfare, Government of India; 2008.Google Scholar
Salminen, EK, Kiel, K, Ibbott, GS, Joiner, MC, Rosenblatt, E, Zubizarreta, E, et al. International conference on advances in radiation oncology (ICARO): Outcomes of an IAEA meeting. Radiat Oncol. 2011;6:11.CrossRefGoogle Scholar
Taylor, A, Powell, ME. Intensity-modulated radiotherapy – what is it? Cancer Imaging. 2004;4:68–73.10.1102/1470-7330.2004.0003CrossRefGoogle Scholar
Government of India, Ministry of Home Affairs, Office of Registrar General and Census Commissioner, India, 2011 Census data. Available from: http://www.censusindia.gov.in/. (Assessed March 2, 2017).Google Scholar
Government of India, Ministry of Statistics and Programme Implementation, National Sample Survey Organization (NSSO). NSSO 71st Round (January–June 2014): Key indicators of social consumption in India health. New Delhi: Ministry of Statistics and Programme Implementation; 2015Google Scholar
Krol, M, Brouwer, W, Rutten, F. Productivity costs in economic evaluations: Past, present, future. Pharmacoeconomics. 2013;31:537–49.CrossRefGoogle ScholarPubMed
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