Cost-Effectiveness of Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy: a Critical Review.

PURPOSE OF REVIEW: This review aims to summarize and appraise published cost-effectiveness studies on stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT).

RECENT FINDINGS: We performed a Medline search of cost-effectiveness studies of SRS, SBRT, and other cancer treatment modalities such as surgery and systemic therapy from 2006 to 2016. We included studies that used both modeling and retrospective review techniques. We excluded studies of benign disease. We defined a strategy whose incremental cost-effectiveness ratio (ICER) is ≤$50,000/quality-adjusted life year (QALY) as "clearly cost-effective," a strategy whose ICER is ≤$100,000/QALY as "probably cost-effective," and a strategy ≤$200,000/QALY as "possibly cost-effective." We appraised modeling studies by determining whether or not they conform to the International Society for Pharmacoeconomics and Outcomes Research Good Research Practices (ISPOR) in modeling task force good research practices in model transparency and validation. We identified 24 studies that met inclusion criteria. Treatment sites included brain, bone, liver, lung, pancreas, and prostate. SRS and SBRT were clearly cost-effective strategies in 17 studies, probably cost-effective in 3 studies, and possibly cost-effective in 2 studies. Of the 16 modeling studies,15 conformed to transparency best practices; however, only 6 studies performed rigorous validation as described by the ISPOR guidelines.

CONCLUSIONS: SRS and SBRT are likely to be cost-effective management strategies across a large variety of treatment sites and techniques. However, rigorous model validation techniques are lacking in these modeling studies.