The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases

BACKGROUND: Radiosurgery can be delivered through a variety of modalities including robotic and fixed gantry Linac-based systems. They appear equally effective and safe. Thus, community need and costs remain the main determinants for choosing a given modality. We performed an economic evaluation to identify settings in which one modality could be preferred over the other. METHODS: Using local estimates of resource volumes and unit prices, we computed the incremental cost/patient of robotic radiosurgery compared to fixed-gantry radiosurgery from a payer's perspective. By varying parameters of resource volumes, we performed a probabilistic analysis stratified by number of brain lesions. in addition, we performed sensitivity analyses to examine the effect of patient volume on cost/patient. RESULTS: The cost of robotic radiosurgery was $4,783/patient, and cost of fixed-gantry radiosurgery was $5,166/patient. The mean incremental cost was $-383 (95% interval: $-670, $110) for all lesions, $78 ($23, $123) for solitary lesions, and $-610 ($-679, $-534) for multiple lesions. The cost/patient of robotic radiosurgery varied from $5,656 (low volume setting) to $4,492 (high volume setting). CONCLUSION: in settings of moderate to high volume (6-10 hours of daily operation), and in multiple lesions, robotic radiosurgery is more cost effective than fixed-gantry radiosurgery. Technique utilisée et coût de la radiochirurgie pour le traitement de 1 à 3 métastases cérébrales.