Transcript Is IMRT good value for money?

Value of Money in Cancer
- IMRT as a case study
Jean H.E. Yong, MASc
Pharmacoeconomics Research Unit, Cancer Care Ontario
Canadian Centre for Applied Research in Cancer Control
Applied Health Research Centre, St. Michael’s Hospital
Key messages
 It is important to consider Value for Money when planning and
coordinating cancer care
 Assessing value for money is not difficult, but needs to be relevant to
the context
 Let’s try to provide value for money every step along the cancer
journey
Value for money
 We want to buy as much health as possible
 But, we have limited resources
 Economics:
 How much does something cost?
 What do we get for what we pay?
 Cost-effectiveness analysis
A costs $1
million
B costs $1
million
Value for money in Cancer
70
60
50
40
Others
Asia Pacific
Europe
North America
30
20
10
0
2004
2005
2006
2007
2008
2009
2010
350 publications in all
disease areas in 2010
Data: The Center for Evaluation of Value and Risk in Health, CEA Registry
Intensity-Modulated Radiation Therapy (IMRT)
 Introducing IMRT across Ontario
 Which disease sites?
 Is IMRT good value for money?
 Can we afford it?
Picture: Radiation Medical Group
Systematic review for
clinical guidelines
Activity-based costing
Survey of radiation oncologists,
physicists, therapists
Literature review to
populate models
Claims data analysis
2
models
Localized prostate cancer
Clinically
localized
disease
Biochemical
failure
Metastasis
Dead
No toxicity
Grade 2 GI
toxicity
Grade 3 GI
toxicity
Biochemical
failure
Metastasis
Dead
IMRT vs. 3D-CRT in prostate cancer
IMRT
CRT
Incremental
Radiation treatment cost
$14,520
$13,501
$1,019
Radiotherapy toxicity cost
$106
$508
$(402)
$60,138
$59,518
$621
Life-years gained (discounted at 5%)
8.257
8.257
0.000
QALYs gained (discounted at 5%)
6.085
6.062
0.023
Total cost (discounted at 5%)
Incremental cost per QALY gained
$26,768
Sensitivity analysis
 Results were sensitive to the disease control assumption and
treatment cost difference
 When IMRT is delivered at a higher dose than CRT, it is cost saving
and is more effective
 When we add Volumetric Modulated Arc Therapy to IMRT, IMRT
has shorter treatment time than CRT and becomes cost saving
 We estimated cost of IMRT for a mature program. In a start-up
program scenario, IMRT costs $279,850 per QALY.
IMRT vs. 2D-RT in head and neck cancers
 Compared with 2D-RT, IMRT reduces xerostomia and improves
quality of life
 IMRT is less expensive than CRT
 saves $1100 per patient
 IMRT takes longer to plan but less time to deliver
 Results are most sensitive to the cost difference between
treatment
 In a start up program scenario: $162,000 per QALY
Discussion
 Results are specific to the research questions
 Not generalizable to other indications
 Specific to the comparator
 Radiotherapy costs vary across countries
 Validate model
 Literature review and sensitivity analysis
Success Factors
 An in house health economics unit
 Effective partnerships with many stakeholders
 Academics
 Community providers
 Evaluation part of an implementation strategy
Cancer journey
Prevention
Screening
Diagnosis
Treatment
Recovery
and
palliative
Prevention
Screening
Diagnosis
Value for money in Cancer
313 studies (2004-2010)
Data: The Center for Evaluation of Value and Risk in Health, CEA Registry
Treatment
Recovery
and
palliative
Key messages
 It is important to consider Value for Money when planning and
coordinating cancer care
 Assessing value for money is not difficult, but needs to be relevant to
the context
 Let’s try to provide value for money every step along the cancer
journey
Acknowledgements
 Dr. Jeffrey Hoch & Jaclyn Beca
 Cancer Care Ontario
 Community practitioners
 Radiation oncologists, physicists, therapists
 Academic collaborators
 Drs. Tom McGowan and Murray Krahn
 IMRT Indications Expert Panel
 Drs. Brian O’Sullivan and Glenn Bauman
Ontario Ministry of Health and Long-Term Care
[email protected]
Thank you.
Cancer Care in Canada
 Universal health care
 Limited access to
interventions that are not
covered by public payers




Public health agency
Provincial cancer agencies
Provincial drug plans
Hospitals
Activity-based costing
Consultation
CT
simulation
Planning
Physics QA
Treatment
delivery &
review visits