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The cost-effectiveness of surgical resection and cesium-131 intraoperative brachytherapy versus surgical resection and stereotactic radiosurgery in the treatment of metastatic brain tumors

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Abstract

This study aims to evaluate the cost-effectiveness of surgical resection (S) and Cesium-131 (Cs-131) [S + Cs-131] intraoperative brachytherapy versus S and stereotactic radiosurgery (SRS) [S + SRS] for the treatment of brain metastases. Treatment records as well as hospital and outpatient charts of 49 patients with brain metastases between 2008 and 2012 who underwent S + Cs-131 (n = 24) and S + SRS (n = 25) were retrospectively reviewed. Hospital charges were compared for the single treatment in question. Means and curves of survival time were defined by the Kaplan–Meier estimator, with the cost analysis focusing on the time period of the relevant treatment. Quality adjusted life years (QALY) and Incremental cost-effectiveness ratios (ICER) were calculated for each treatment option as a measure of cost-effectiveness. The direct hospital costs of treatments per patient were: S + Cs131 = $19,271 and S + SRS = $44,219. The median survival times of S + Cs-131 and S + SRS were 15.5 and 11.3 months, and the 12 month survival rates were 61 % and 49 % (P = 0.137). The QALY for S + SRS when compared to S + Cs-131 yielded a p < 0.0001, making it significantly more cost-effective. The ICER also revealed that when compared to S + Cs-131, S + SRS was significantly inferior (p < 0.0001). S + Cs-131 is more cost-effective compared with S + SRS based on hospital charges as well as QALYs and ICER. Cost effectiveness, in addition to efficacy and risk, should factor into the comparison between these two treatment modalities for patients with surgically resectable brain metastases.

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Abbreviations

Cs-13:

Cesium-131

I-125:

Iodine-125

ICER:

Incremental cost-effectiveness ratio

KPS:

Karnofsky performance status

LINAC:

Linear accelerators

QALY:

Quality adjusted life year

SRS:

Stereotactic radiosurgery

S:

Surgical resection

WBRT:

Whole brain radiotherapy

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Acknowledgments

Parts of this manuscript were presented at the Society for Neuro-Oncology in 2012, Washington, DC. Doctor Wernicke supported by the funds from the National Institute of Health CTSC KL2 Comparative Effectiveness Research Award UL1-TR000457.

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Authors and Affiliations

  1. Department of Radiation Oncology, Stich Radiation Oncology, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA

    A. Gabriella Wernicke, Menachem Z. Yondorf, Bhupesh Parashar, Dattatreyudu Nori & K. S. Clifford Chao

  2. Department of Neurological Surgery, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA

    A. Gabriella Wernicke, John A. Boockvar, Susan Pannullo, Philip Stieg & Theodore H. Schwartz

  3. Department of Otolaryngology, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neuroscience, Weill Cornell Medical College of Cornell University, New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

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  1. A. Gabriella Wernicke
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  2. Menachem Z. Yondorf
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Correspondence to A. Gabriella Wernicke.

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The 1st authorship is shared between the authors A. Gabriella Wernicke and Menachem Z. Yondorf.

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Wernicke, A.G., Yondorf, M.Z., Parashar, B. et al. The cost-effectiveness of surgical resection and cesium-131 intraoperative brachytherapy versus surgical resection and stereotactic radiosurgery in the treatment of metastatic brain tumors. J Neurooncol 127, 145–153 (2016). https://doi.org/10.1007/s11060-015-2026-4

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