Cost-effectiveness analysis of SBRT versus IMRT: an emerging initial radiation treatment option for organ-confined prostate cancer

The purpose of this study is to compare the cost-effectiveness of 2 external beam radiation therapy techniques for treatment of lowto intermediate-risk prostate cancer: stereotactic body radiation therapy (SBRT) and intensitymodulated radiation therapy (IMRT). A Markov decision analysis model with probabilistic sensitivity analysis was designed with the various disease states of a 70-year-old patient with organ-confined prostate cancer to evaluate the cost-effectiveness of 2 external beam radiation treatment options. The Monte Carlo simulation revealed that the mean cost and quality-adjusted life-years (QALYs) for SBRT and IMRT were $22,152 and 7.9 years and $35,431 and 7.9 years, respectively. The sensitivity analysis revealed that if the SBRT cohort experienced a decrease in quality of life of 4% or a decrease in efficacy of 6%, then SBRT would no longer dominate IMRT in cost-effectiveness. In fact, with these relaxed assumptions for SBRT, the incremental cost-effectiveness ratio of IMRT met the societal willingness to pay threshold of $50,000 per QALY. Compared with IMRT, SBRT for lowto intermediate-risk prostate cancer has great potential cost savings for our healthcare system payers and may improve access to radiation, increase patient convenience, and boost quality of life for patients. Our model suggests that the incremental cost-effectiveness ratio of IMRT compared with SBRT is highly sensitive to quality-oflife outcomes, which should be adequately and comparably measured in current and future prostate SBRT studies.