Cost-utility analysis of a malignant glioma protocol

Purpose: To perform a cost-utility analysis utilizing a cooperative group protocol and constrasting the results with the published quality adjusted survival. Methods and Materials: A cost-utility analysis was performed on Radiation Therapy Oncology Group (RTOG) protocol 83-02. The quality-adjusted survival has been published previously. Pretreatment tests and chemotherapy costs are not considered, as these were similar across all treatment arms. Payor costs are calculated from Federal Register data for Medicare Region IV. Global charges are used to calculate the professional and technical charges. Costs are measured in relative value units (RVUs) and are tabulated assuming equal treatment complexity for all treatment arms. Results: The number of RVUs calculated for each arm were 48 Gy-166.65; 54.4 Gy-182.17; 64.8 Gy-232.53; 72.0 Gy-272.19; 76.8 Gy-287.11; and 81.6 Gy- 302.63. The RVU/QALY for the <50-year-old group were 48 Gy-119.03; 54.4 Gy- 100.65;64.8 Gy-104.78; 72.0 Gy-90.73; 76.8 Gy-193.99; and 81.6 Gy-165.37. The RVU/QALY for the >50-year-old group were 48 Gy-198.39; 54.4 Gy-276.85; 64.8 Gy-426.57; 72.0 Gy-423.71; 76.8 Gy-703.70; and 81.6 Gy-519.10. Sensitivity analysis of one treatment plan, simulation, and set of blocks for the 48 Gy and 54.4 Gy arms decreased the RVU/QALY to 105.34 and 90.05, respectively. Discussion: Our analyses shows the experimental arm with the lowest RVU/QALY is also the arm with the longest quality-adjusted survival. This arm had the most efficient use of resources in this protocol. Prospective collection of all pertinent cost data is required for comparison of one treatment against another. All cooperative group protocols should have prospective quality of life and economic endpoints to allow for comparison of the most cost efficient treatment method.