• Lincy S Lal, Stacey DaCosta Byfield, Eric L Chang, Luisa Franzini, Lesley-Ann Miller, Rebecca Arbuckle, Liezl Reasonda, Chun Feng, Andrea Adamus, and John Michael Swint.
• Ingenix Consulting-Healthcare, Missouri City, TX, USA. lincy.lal@ingenixconsulting.com
• Am. J. Clin. Oncol. 2012 Feb 1; 35 (1): 45-50.

BackgroundIn this study, we compare 2 treatment options and determine cost-effectiveness and cost-utility.MethodsWe carried out a decision analysis populated with data from patients with brain metastasis in a concurrent trial randomized to either stereotactic radiosurgery (SRS) and observation or SRS and whole brain radiation therapy. Outcomes included actual life years saved (LYS), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Costs used were from the healthcare perspective and utilities were captured through a time-trade-off method, using 10-year, 5-year, and 1-year time horizons. One-way sensitivity analyses were carried out to determine robustness of the decision analysis model.ResultsCompared with SRS and whole brain radiation therapy, SRS and observation not only had a higher average cost ($74,000 vs $119,000, respectively) but also a higher average effectiveness (0.60 LYS vs 1.64 LYS, respectively) with an ICER of $44,231/LYS or $41,783/QALY (with utilities captured using a 10-year horizon). Slightly higher ICER estimates were achieved with utilities captured using the other time horizons ($43,280/QALY and $44,064/QALY, respectively). Sensitivity analysis showed that the following variables had the highest impact on the ICER: probability of no recurrence in recursive-partitioning analysis class 2 after SRS and observation; probability of being alive after SRS and observation in recursive-partitioning analysis class 2 and being treated for recurrence.ConclusionsCompared with other interventions in the $50,000 to $100,000/QALY cost-effectiveness range, the application of SRS and observation, with subsequent neurosurgical management of recurrences, is shown to be a reasonable treatment modality for brain metastases.

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