1100 - Cost Effectiveness of Prophylactic Bone Irradiation for Prevention of Skeletal-Related Events in Patients with Metastatic Solid Cancers
Presenter(s)
S. M. Chacko1, N. H. Lester-Coll2, and J. B. Yu3; 1Geisel School of Medicine at Dartmouth, Hanover, NH, 2University of Vermont Health Network, Burlington, VT, 3Department of Radiation Oncology & Applied Sciences, Dartmouth Cancer Center, Lebanon, NH
Purpose/Objective(s): Bone metastases that are large or located in high-risk sites, such as the hip or spine, are more likely to lead to skeletal-related events (SRE), such as pathologic fractures or spinal cord compression. These complications can be debilitating and significantly reduce quality of life, highlighting the need for early intervention. Preventative external-beam radiation therapy (EBRT) to these lesions may be effective in reducing progression to SREs. The efficacy and survival outcomes of prophylactic radiation are currently being measured in Phase III randomized trial NRG-CC014. In anticipation of the trial’s completion, this study evaluates the cost-effectiveness of prophylactic EBRT for high-risk asymptomatic bone metastases.
Materials/Methods: A Markov model was developed to simulate patients with solid tumors and high-risk asymptomatic skeletal metastases who either received prophylactic EBRT or standard of care over four years. The model incorporated costs, health state utilities, and risks of progression to SREs and death. Transition probabilities were derived from Gillespie et al. (JCO 2023), and monthly costs and utilities were obtained from published literature. Cost effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER), with a value below the societal willingness-to-pay threshold of $150,000 per quality-adjusted life year (QALY) considered cost-effective.
Results: Prophylactic EBRT resulted in 3.82 additional quality adjusted life months (QALMs) compared to no EBRT at an increased cost of $10,038, corresponding to an ICER of $31,524/QALY. EBRT remained cost-effective at a willingness-to-pay threshold of $150,000/QALY for monthly radiation costs up to $47,750.
Conclusion: This study found that prophylactic EBRT for high-risk asymptomatic bone metastases in patients with solid tumors can be a cost-effective option in the prevention of further bone-related complications. Final cost-effectiveness estimates will be strengthened with mature survival and efficacy data upon completion of the NRG-CC014 trial.