A comparison of surgical intervention and stereotactic body radiation therapy for stage i lung cancer in high-risk patients: A decision analysis

Varun Puri, Traves D. Crabtree, Steven Kymes, Martin Gregory, Jennifer Bell, Jeffrey D. Bradley, Clifford Robinson, G. Alexander Patterson, Daniel Kreisel, Alexander S. Krupnick, Bryan F. Meyers

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

Abstract

Objective: We sought to compare the relative cost-effectiveness of surgical intervention and stereotactic body radiation therapy in high risk patients with clinical stage I lung cancer (non-small cell lung cancer). Methods: We compared patients chosen for surgical intervention or SBRT for clinical stage I non-small cell lung cancer. Propensity score matching was used to adjust estimated treatment hazard ratios for the confounding effects of age, comorbidity index, and clinical stage. We assumed that Medicare-allowable charges were $15,034 for surgical intervention and $13,964 for stereotactic body radiation therapy. The incremental cost-effectiveness ratio was estimated as the cost per life year gained over the patient's remaining lifetime by using a decision model. Results: Fifty-seven patients in each arm were selected by means of propensity score matching. Median survival with surgical intervention was 4.1 years, and 4-year survival was 51.4%. With stereotactic body radiation therapy, median survival was 2.9 years, and 4-year survival was 30.1%. Cause-specific survival was identical between the 2 groups, and the difference in overall survival was not statistically significant. For decision modeling, stereotactic body radiation therapy was estimated to have a mean expected survival of 2.94 years at a cost of $14,153 and mean expected survival with surgical intervention was 3.39 years at a cost of $17,629, for an incremental cost-effectiveness ratio of $7753. Conclusions: In our analysis stereotactic body radiation therapy appears to be less costly than surgical intervention in high-risk patients with early stage non-small cell lung cancer. However, surgical intervention appears to meet the standards for cost-effectiveness because of a longer expected overall survival. Should this advantage not be confirmed in other studies, the cost-effectiveness decision would be likely to change. Prospective randomized studies are necessary to strengthen confidence in these results.

Original languageEnglish
Pages (from-to)428-436
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number2
DOIs
StatePublished - Feb 2012

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