An economic analysis of Radiation Therapy Oncology Group 94-10: cost-efficacy of concurrent vs. sequential chemoradiotherapy

Abstract

Background

Cost can be a major issue in therapeutic decision-making and in particular for patients with locally advanced non-small cell lung cancer (LA-NSCLC).

Methods

The specific aim of this analysis was to evaluate the costs and outcomes of patients treated on Radiation Therapy Oncology Group (RTOG) 94-10, Medicare Part A and Part B costs from all for patients treated from 1991 to 1996 on RTOG 94-10, a phase III trial showing a survival benefit for concurrent chemoradiation (STD RT) over sequential (RT day 50) chemoradiation in LA-NSCLC with intermediate outcome for concurrent twice daily radiation and chemotherapy (HFX RT). Twenty-six-month expected costs for each arm of the trial in 1996 dollars were determined, with Kaplan-Meier sampling average estimates of survival probabilities for each month and mean monthly costs. The analysis was performed from a payer’s perspective. Incremental cost-effectiveness ratios were calculated comparing RT on day 50 and HFX RT to the STD RT.

Results

Of the 610 patients entered, Medicare cost data and clinical outcomes were available for 92 patients. In this subset, compared to STD RT, RT on day 50 proved less costly but resulted in reduced survival at 1 year. In addition, HFX RT costs slightly more than STD RT but was less effective in this cohort of patients.

Conclusions

In patients with Medicare insurance and with significant toxicity burden, RT on day 50 is the least expensive but also least effective treatment in this subset of patients treated on RTOG 94-10.