using&evidence&to&provide&value&for money&–&a&case&study ......
TRANSCRIPT
Using Evidence to Provide Value for Money – A Case Study in a Provincial Cancer Agency Jean H.E. Yong, MASc Pharmacoeconomics Research Unit, Cancer Care Ontario Health Economics, St. Michael’s Hospital Canadian Centre for Applied Research in Cancer Control
Overview § Case study: Cost-‐effectiveness analyses of IMRT § Benefits of an in-‐house health economics unit
Radiotherapy
Radiotherapy
Intensity-Modulated Radiotherapy (IMRT)
2 models
Program for Evidence-‐Based Care (PEBC) conducted 10 systematic reviews for clinical guidelines
Activity-‐based costing
Surveyed radiation oncologists for treatment pattern
Literature review to populate models
2 Cost-‐effectiveness Analyses
Activity-‐based costing – Costs of RT
Consultation Imaging Planning Physics QA Treatment delivery & review visits
Activity-‐based costing – Costs of RT
Consultation • Radiation oncologists • Nurse • Overhead
Imaging • Radiation therapist • CT simulator • Immobilizer • Overhead
Planning • Radiation therapist • Planning system • Radiation oncologist • Overhead
Physics QA • Physicist & physics associates • QA equipment • Planning system • Overhead
Treatment delivery & review visits • Radiation therapist • Linear accelerator • Radiation oncologist • Nurse • Overhead
Localized prostate cancer
Toxicity – IMRT vs. conventional RT
Duration Grade 2 Grade 3
Acute gastrointestinal 2 months 16% vs. 33% 0 vs. 13%
Late gastrointestinal 36 months 5% vs. 13% 0 vs. 0
Localized disease
Biochemical failure
Metastasis
Dead
Localized prostate cancer
No toxicity Biochemical
failure
Metastasis
Dead
Grade 2 GI toxicity
Grade 3 GI toxicity
Localized disease
IMRT vs. 3D-‐CRT in prostate cancer IMRT CRT Incremental
Radiation treatment cost $14,520 $13,501 $1,019
Radiotherapy toxicity cost $106 $508 $(402)
Total cost (discounted at 5%) $60,138 $59,518 $621
Life-‐years gained (discounted at 5%) 8.257 8.257 0.000
QALYs gained (discounted at 5%) 6.085 6.062 0.023
Incremental cost per QALY gained $26,768
Sensitivity analysis § When IMRT is delivered at a higher dose than CRT, it is cost saving and is more effective
§ Cost-‐effectiveness of IMRT improves over time § In a start-‐up program scenario, IMRT costs $279,850 per QALY § When we add Volumetric Modulated Arc Therapy (VMAT) to IMRT, IMRT has shorter treatment time than CRT and becomes cost saving
Xerostomia – dry mouth
IMRT 2D-‐RT
29% 83%
http://www.irishdentist.ie
IMRT vs. 2D-‐RT in head and neck cancer IMRT 2D-‐RT Incremental
Radiation treatment cost $16,085 $14,493 $1,592
Life-‐years gained 15.46 15.46 0.00
QALYs gained (discounted at 5%) 8.65 8.17 0.48
Incremental cost per QALY gained $3,307
Incremental cost per case of severe
long-‐term xerostomia averted
$2,948
Case study summary § IMRT appears cost-‐effective in prostate and head & neck cancers § Results are specific to the research questions
§ Not generalizable to other indications § Specific to the comparator § Radiotherapy costs vary across countries
§ Cost-‐effectiveness is much less favorable in a start-‐up scenario and improves over time with experience
§ Capital cost is the main cost driver in radiotherapy
Success factors
Cost-‐utility analyses in Canada
Non-‐cancer, 164
Prevention, 4 Detection, 4
Treatment, 36
Survivorship/ end-‐of-‐life care, 1
Cancer, 45
Yong JHE, Kerner J, Hoch J (under review)
Key messages
Acknowledgements § Dr. Jeffrey Hoch & Jaclyn Beca § Cancer Care Ontario § Community practitioners
§ Radiation oncologists, physicists, radiation therapists § Academic collaborators
§ Karen Bremner, Drs. Tom McGowan, Murray Krahn, Brian O’Sullivan and Glenn Bauman
Ontario Ministry of Health and Long-‐Term Care
Thank you. [email protected]