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Cost Effectiveness Analysis of Radiofrequency Ablation (RFA) Versus Stereotactic Body Radiotherapy (SBRT) for Early Stage Renal Cell Carcinoma (RCC)

Published:March 27, 2022DOI:https://doi.org/10.1016/j.clgc.2022.03.011

      Abstract

      Objectives

      To conduct a cost-effectiveness analysis of stereotactic body radiotherapy (SBRT) versus radiofrequency ablation (RFA) in the non-surgical management of early stage renal cell carcinoma (RCC) according to Consolidated Health Economic Evaluation Reporting Standards (CHEERS) criteria in the Canadian healthcare system.

      Methods

      A Markov state transition model was constructed for initial local treatment with RFA or SBRT for early stage, kidney confined, medically inoperable RCC in a hypothetical cohort. Incremental cost effectiveness ratios (ICER) were then calculated to compare the two treatments. The analysis was conducted over 5-year time horizon from the perspective of a publicly funded health system in Canada. Secondary analyses were conducted to assess the effect of small versus large size (< 4 cm vs. > 4 cm) RCC on ICERs. Multiple one-way deterministic sensitivity analysis were conducted. Discounting of 1.5% per year was applied.

      Results

      Over 5 years, SBRT economically dominated RFA with a gain of 4.103 quality-adjusted life years (QALYs) and a cost of $16,097, compared with 3.607 QALYs at a cost of $18,324 for RFA. The ICER was $4490 CAD less per QALY for SBRT in the base case analysis (BCE). In patients with small tumors (T1a), SBRT compared with RFA was more effective and marginally more costly, resulting in an ICER of $2207 CAD per QALY gained, while for larger tumors (T1b), SBRT was less costly and more effective than RFA, resulting in an ICER of -$22904. Sensitivity analysis demonstrated significant variability in the cost-effectiveness of SBRT versus RFA when parameters were varied, with rates of distant metastasis following RFA or SBRT having the greatest implications on ICERs.

      Conclusion

      Overall, SBRT used as a primary treatment for RCC shows promising effectiveness at an overall reduction in cost compared with RFA in the Canadian healthcare system. The use of SBRT appears to be cost-effective for larger tumors as well as smaller tumors. The validity of these conclusions are highly sensitive to the accuracy of local and distant progression rates reported in previous studies, and may be adjusted as the available data on SBRT and RFA continues to evolve and mature.

      Keywords

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      References

        • Kachura J
        • Baldassarre F
        • Kielar A
        • Baerlocher M.
        Focal Tumour Ablation for Renal Cell Carcinoma.
        Cancer Care Ontario, Toronto (ON)2016 July 7 (Program in Evidence-based Care Evidence Summary No.: FA-3)
        • Olweny EO
        • Park SK
        • Yk Tan
        • Best SL
        • Trimmer C
        • Caddedu JA.
        Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years follow up.
        Eur Urol. 2012; 61: 1156-1161
        • Wah T
        • irving CH
        • Gregory W
        • Cartledge J
        • Joyce A
        • Selby P.
        Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours.
        BJU Int. 2014; 113: 416-428
        • Ma Y
        • Bedir S
        • Caddedu J
        • Gahan J.
        Long-term outcomes in health adults after radiofrequency ablation of T1a renal tumors.
        BJU Int. 2014; 113: 51-55
        • Curry D
        • Yassin M
        • Thwaini A
        • et al.
        Radiofrequency ablation of renal cell carcinoma: a follow up of outcomes.
        Can J Urol. 2014; 21: 7135-7140
      1. Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA. Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. 2013. 63 :486-92.

        • Kunkle DA
        • Uzzo RG.
        Cryoablation or radiofrequency ablation of the small renal mass: a meta-analysis.
        Cancer. 2008; 113: 2671-2680
      2. Bhan S, Paulter S, Shayegan B, et al. Active surveillance, radiofrequency ablation, or cryoablation for the nonsurgical management of a small renal mass: a cost-utility analysis. 2013. 20:3675-3684.

        • Pandharipande PV
        • Gervais DA
        • Mueller PR
        • Hur C
        • Gazelle GS.
        Radiofrequency ablation versus nephron-sparing surgery for small unilateral renal cell carcinoma: cost-effectiveness analysis.
        Radiology. 2008; 248: 169-178
        • Correa RJM
        • Ahmad B
        • Warner A
        • et al.
        A prospective phase I dose-escalation trial of stereotactic ablative radiotherapy (SABR) as an alternative to cytoreductive nephrectomy for inoperable patients with metastatic renal cell carcinoma.
        Radiat Oncol. 2018; 13: 47
        • Siva S
        • Pham D
        • Gill S
        • Corcoran NM
        • Foroudi F
        A systematic review of stereotactic radiotherapy ablation for primary renal cell carcinoma.
        BJU Int. 2012; 110: E737-E743
        • Siva S
        • Jackson P
        • Kron T
        • et al.
        Impact of stereotactic radiotherapy on kidney function in primary renal cell carcinoma: establishing a dose – response relationship.
        Radiother Oncol. 2016; 118: 540-546
        • Ponsky L
        • Lo SS
        • Zhang Y
        • et al.
        Phase I dose-escalation study of stereotactic body radiotherapy (SBRT) for poor surgical candidates with localized renal cell carcinoma.
        Radiother Oncol. 2015; 117: 183-187
        • Siva S
        • Pham D
        • Kron T
        • et al.
        Stereotactic ablative body radiotherapy for inoperable primary kidney cancer: a prospective clinical trial.
        BJU int. 2017; 120: 623-630
        • Siva S
        • Chesson B
        • Bressel M
        • et al.
        TROG 15.03 phase II clinical trail of focal ablative stereotactic radiosurgery for cancers of the kidney- FASTRACK II.
        BMC Cancer. 2018; 18: 1030
        • Siva S
        • Louie AV
        • Warner A
        • et al.
        Pooled analysis of stereotactic body radiotherapy for primary renal cell carcinoma: A report from the international radiosurgery oncology consortium for kidney (IROCK).
        Cancer. 2018; 124: 934-942
        • Matin SF
        • Ahrar K
        • Cadeddu JA
        • et al.
        Residual and recurrent disease following renal energy ablative therapy: a multi-institutional study.
        J Urol. 2006; 176: 1973-1977
        • Breda A
        • Anterasian C
        • Belldegrun A.
        Management and outcomes of tumor recurrence after focal ablation renal therapy.
        J Endourol. 2010; 24: 749-752
        • Long I
        • Park S.
        Difference in patterns of care: reablation and nephrectomy rates after needle ablative therapy for renal masses stratified by medical specialty.
        J Endourol. 2009; 23: 421-426
        • Husereau D
        • Drummond M
        • Petrou S
        • et al.
        Consolidated health economic evaluation reporting standards (CHEERS)- Explanation and elaboration: a report of the ISPOR health economic evaluations publication guidelines good reporting task force.
        Value Health. 2013; 16: 231-250
        • Nguyen TK
        • Goodman CD
        • Bolt RG
        • et al.
        Evaluation of health economics in radiation oncology: a systematic review.
        Radiat Oncol Biol Phys. 2016; 94: 1006-1014
      3. Guidelines for the economic evaluation of health technologies: Canada.
        Ottawa: CADTH. 4th ed. 2017
        • Kim H
        • Gill B
        • Beriwal S
        • Huq MS
        • Roberts MS
        • Smith KJ
        Cost-effectiveness of stereotactic body radiation therapy compared with radiofrequency ablation for inoperable colorectal liver metastasis.
        Int J Radiat Oncol Biol Phys. 2016; 95: 1175-1183
        • Pollom EL
        • Lee K
        • Durkee BY
        • et al.
        Cost-effectiveness of stereotactic body radiation therapy versus radiofrequency ablation for hepatocellular carcinoma.
        Radiology. 2017; 283: 460-468
        • Swaminath A
        • Niglas M
        • Cheung P
        • et al.
        Patient-reported quality of life following stereotactic body radiation therapy for primary kidney cancer: Results from a Prospective Cohort Study.
        Int J Radiat Oncol Biol Phys. 2018; 102: E93-E94
        • Warren B
        • Munoz-Schuffenegger P
        • Chan KKW
        • et al.
        Quantifying health utilities in patients undergoing stereotactic body radiation treatment for liver metastasis for use in future economic evaluations.
        Clin Oncol (R Coll Radiol). 2017; 29: e-141-147
        • Amdahl J
        • Diaz J
        • Park J
        • Nakhaipour HR
        • Delea TE.
        Cost-effectiveness of pazapanib compared with sunitinib in metastatic renal cell carcinoma in Canada.
        Current Oncology. 2016; 23: 340-354
        • Wu B
        • Zhang Q
        • Sun J.
        Cost-effectiveness of nivolumab plus ipilumimab as first-line therapy in advanced renal cell carcinoma.
        J Immunother Cancer. 2018; 6: 124
        • Wiering B
        • Oyen WJG
        • Adang EMM
        • et al.
        Long-term global quality of life in patients treated for colorectal liver metastases.
        Br J Surg. 2011; 98: 565-571
        • Roberts KJ
        • Sutton AJ
        • Prasad KR
        • et al.
        Cost-utility analysis of operative versus non-operative treatment for colorectal liver metastases.
        Br J Surg. 2015; 102: 388-398
        • Romero AM
        • Wunderink W
        • van Os RM
        • et al.
        Quality of life after Stereotactic body radiation therapy for primary and metastatic liver tumors.
        Int J Radiat Oncol Biol Phys. 2008; 70: 1447-1452
        • Jackson WC
        • Tao Y
        • Owen D
        • et al.
        Comparison of stereotactic body radiation therapy and radiofrequency ablation in the treatment of intra-hepatic metastasis.
        Int J Radiat Oncol Biol Phys. 2018; 100: 950-958
        • Siva S.
        • Correa R.
        • Warner A.
        • et al.
        Stereotactic ablative radiotherapy for ≥T1b primary renal cell carcinoma: a report from the International Radiosurgery Oncology Consortium for Kidney (IROCK).
        Int J Radiat Oncol Biol Phys. 2020; 108: 941-949
        • Mitera G
        • Swaminath A
        • Rudoler D
        • et al.
        Cost-effectiveness analysis comparing conventional versus stereotactic body radiotherapy for surgically ineligible stage I non-small cell lung cancer.
        Journal of Oncology Practice. 2014; 10: 130-136
        • Kouakou C.R.C.
        • Poder T.G.
        Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression.
        Eur J Health Eco. 2022; 23 (doi:): 277-299https://doi.org/10.1007/s10198-021-01364-3
        • Stone CJL
        • Johnson AP
        • Robinson D
        • et al.
        Health resource and cost savings achieved in a multidisciplinary lung cancer clinic.
        Curr Oncol. 2021; 28 (PMID: 33947127; PMCID: PMC8161784): 1681-1695https://doi.org/10.3390/curroncol28030157