Costing the components of pain management. Analysis of Trans-Tasman Radiation Oncology Group trial (TROG 96.05): One versus five fractions for neuropathic bone pain

Bone metastases causing neuropathic pain (NBP) have traditionally been treated with fractionated radiotherapy (RT). A recently reported randomised Trans-Tasman Radiation Oncology Group trial (TROG 96.05) supports this approach in many cases [Roos DE, Turner SL, O'Brien PC et al. Randomised trial of 8Gy in 1 versus 20Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans-Tasman Radiation Oncology Group, TROG 96.05). Radiother Oncol 2005;75:54–63]. This study sought to compare costs to the Australian health-care system for patients receiving 1 versus 5 fractions for NBP. The RT and medication costs for 245 patients treated on TROG 96.05 were determined from trial data out to 3 months from RT. Admission costs and causes were derived from hospital records. RT costs (including re-treatments) were calculated to be 222 and 724 Australian dollars (A$) per patient for the 8Gy/1 and 20Gy/5 arms, respectively. This difference increased when analgesics (A$192 versus A$229) and related hospital admissions (A$1411 versus A$1893) were considered. Sensitivity analysis demonstrated an incremental cost saving of between A$795 and A$1468 for single fraction RT. Admission rates had the strongest potential to distort cost differences. Clinical outcomes are paramount in choice of fractionation scheme but are optimally considered in the light of economic implications. Overall cost differences between fractionation schedules may vary greatly from those incurred by the RT treatment centre alone. Ideally, such economic evaluations should be planned at the outset of a trial.