Patients diagnosed with multiple brain metastases often survive for less than two years, and for these patients in particular, clinicians must carefully evaluate the impact of oncologic interventions on quality of life. Three types of radiation treatment are widely accepted among physicians for treating patients with multiple brain metastases: whole brain radiation therapy (WBRT), hippocampal avoidance whole brain radiation therapy (HA-WBRT), and stereotactic radiosurgery (SRS). WBRT, the standard option, is less costly than its newer alternatives HA-WBRT and SRS, but also causes more severe adverse effects such as memory loss. In this project, a Markov model was designed using data from previously published studies to simulate the disease course of patients with five to fifteen brain metastases and determine the cost-effectiveness of HA-WBRT and SRS relative to WBRT. Incremental cost-effectiveness ratios (ICERs) were calculated and compared against a willingness-to-pay threshold of $100,000 per quality-adjusted life year. The results showed that while SRS met the threshold for cost-effectiveness, with ICERs ranging from $41,198 to $54,852 for patients with five to fifteen brain metastases, HA-WBRT was not cost-effective with an ICER of $163,915 for all simulated patients. The model results were robust to sensitivity analyses. Therefore, we propose that SRS, but not HA-WBRT, should be offered to patients with multiple brain metastases as a treatment alternative to standard WBRT. Incorporating these findings into clinical practice will help promote patient-centered care and decrease national healthcare expenditures, thereby addressing issues around health equity and access to care.
Chen, Victor, "Cost-Effectiveness Analysis of Three Radiation Treatment Strategies for Patients with Multiple Brain Metastases" (2021). Master of Public Health Capstone Presentations. Presentation 378.