Cost-Effectiveness of SABR in Oligometastatic Cancer: An Economic Analysis Based on Long-Term Results of the SABR-COMET Trial
Conferences
Overview
Research
Identity
Additional Document Info
View All
Overview
abstract
Purpose/objective(s)
Our published economic analysis of the SABR-COMET randomized trial determined that SABR is cost-effective for patients with 1-5 oligometastases, with incremental cost-effectiveness ratios (ICERs) of $37,157 (2018 CAD$) and $54,564 (2018 USD$) for the Canadian and American health care systems, respectively. Long-term outcomes from SABR-COMET, with a median follow-up of 51 months, are now available. The aim of this study is to re-evaluate the cost-utility of SABR for oligometastatic cancers in the context of these new results.
Materials/methods
The published Markov model was updated to perform a cost-utility analysis based on the long-term results of the SABR-COMET trial from the Canadian and American payer perspectives. Utility values and probabilities were derived from individual patient-level trial data. Costs were extracted from the published literature and adjusted to 2018 Canadian dollars and 2018 US dollars. Deterministic sensitivity analyses were performed to obtain thresholds at which each strategy would be preferred. Probabilistic sensitivity analysis was performed to assess the robustness of this model. A lifetime horizon was used with a cycle length of 3 months. A willingness-to-pay threshold of $100,000 in each respective currency, per quality-adjusted life year (QALY) was used. QALYs and costs were discounted at a rate of 1.5% and 3% for Canadian and American analyses, respectively.
Results
In the base case scenario, SABR was cost-effective at an ICER of $30,793 (CAD) and $48,370 (USD) per QALY gained. This finding was most sensitive to the difference in systemic therapy use (ICER: $25,051-48,021[CAD]; $36,319-69,096 [USD]), number of metastatic lesions treated with SABR (ICER: $22,702-44,709 [CAD]; $40,868-70,874 [USD]), and variation in general cancer care cost (ICER: $24,780-36,807 [CAD]; $38,377-58,362 [USD]). Probabilistic sensitivity analysis revealed that SABR was a cost-effective strategy in 99.9% of tested iterations.
Conclusion
This updated decision-analytic model suggests that SABR for patients with 1-5 metastatic lesions is more cost-effective than was initially estimated in both Canadian and the American health care systems. As systemic therapies for metastatic cancer are rapidly evolving, the efficacy and value of SABR with novel agents are currently undergoing further prospective evaluation.
