2824 - Oncologic Outcomes and Cost-Effectiveness Analysis of 44Gy/20F EBRT for Locally Advanced Cervical Cancer: Pooled Data from Two Prospective Trials
Presenter(s)
P. Laolugsanalerd1, T. Prasartseree1, C. Kositamongkol2, P. Phisalprapa2, N. Viboonmongkol1, W. Sittiwong3, and P. Dankulchai1; 1Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 2Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 3University College London Hospital, London, United Kingdom
Purpose/Objective(s): Hypofractionated radiotherapy (HYPO) has gained interest in treating locally advanced cervical cancer. This study evaluates the cost-effectiveness of HYPO 44Gy/20F, compared to conventional radiotherapy 45Gy/25F in patients with locally advanced cervical cancer in Thailand.
Materials/Methods: The economic evaluations were conducted based on two key clinical endpoints: progression-free survival (PFS), and overall survival (OS) which derived from two single-center prospective trials, EMBRACE II and HYPOCx-iRex, A pooled analysis of 68 patients from EMBRACE II (N=28, CVRT) and HYPOCx-iRex (DOI: 10.1016/j.ijrobp.2023.06.313 N=40, comprising 19 CVRT and 21 HYPO) was conducted. Patients with stage IB–IVA disease who were treated with VMAT and IGABT between May 2020 and June 2023 were recruited. Treatment costs within the first 2 years of follow-up period were collected to comply with 2-year survival outcome. Incremental cost-effectiveness ratios (ICERs) were calculated from provider and societal perspectives. Sensitivity analyses were performed.
Results: Total numbers of patients were 21 in 44Gy/20F group and 47 in 45Gy/25F group. Oncologic outcomes were presented in the Table. The 2-year PFS were 75.2% (95%CI 50.0-88.9%) for 44Gy/20F and 67.6% (52.1-79.1%) for 45Gy/25F. While 2-year OS was 100% for 44Gy/20F and 76.8% (61.0-86.9%) for 45Gy/25F. External beam radiotherapy (EBRT) cost for 44Gy/20F and 45Gy/25F were $2,256.23 and $2,820.29, respectively. The average two-year total treatment cost per patient (including EBRT) was $11,088.77 for 44Gy/20F and $11,367.88 for 45Gy/25F from a provider perspective, and $11,721.86 and $12,086.43, respectively, from a societal perspective. Therefore, 44Gy/20F could save $47.97 per 1% gain in PFS and $15.71 per 1% gain in OS, compared to 45Gy/25F.
Conclusion: Regard to current evidence, 44Gy/20F demonstrated cost-saving, compared to 45Gy/25F. Longer follow-up period and patients’ quality of life as in cost-utility analysis should be mandated for a more comprehensive evaluation.
Abstract 2824 - Table 1| 44Gy/20F | 45Gy/25F | |
| Costs | ||
| EBRT ($) | 2,256.23 | 2,820.29 |
| Direct medical cost except EBRT ($) | 8,832.53 | 8,546.99 |
| Direct non-medical cost ($) | 362.26 | 411.50 |
| Indirect cost ($) | 270.84 | 307.65 |
| Total cost ($) | 11,721.86 | 12,086.43 |
| Outcomes | ||
| 2-year PFS (%) | 75.2 | 67.6 |
| 2-year OS (%) | 100 | 76.8 |
| ICERs | ||
| Cost saved ($) per 1 % gain in PFS | 47.97 | |
| Cost saved ($) per 1% gain in OS | 15.71 | |