%0 Journal Article
%T Health economics of targeted intraoperative radiotherapy (TARGIT-IORT) for early breast cancer: a cost-effectiveness analysis in the United Kingdom
%A Anil Vaidya
%A Brigitte Both
%A Chris Brew-Graves
%A Jayant S Vaidya
%A Max Bulsara
%A Param Vaidya
%J -
%D 2017
%R 10.1136/bmjopen-2016-014944
%X Objective The clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks¡¯ course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost-effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation.

Setting TARGIT-A randomised clinical trial ([ISRCTN34086741][1]) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy.

Methods Cost-utility analysis using decision analytic modelling by a Markov model. A cost-effectiveness Markov model was developed using TreeAge Pro V.2015. The decision analytic model compared two strategies of radiotherapy for breast cancer in a hypothetical cohort of patients with early breast cancer based on the published health state transition probability data from the TARGIT-A trial. Analysis was performed for UK setting and National Health Service (NHS) healthcare payer¡¯s perspective using NHS cost data and treatment outcomes were simulated for both strategies for a time horizon of 10 years. Model health state utilities were drawn from the published literature. Future costs and effects were discounted at the rate of 3.5%. To address uncertainty, one-way and probabilistic sensitivity analyses were performed.

Main outcome measures Quality-adjusted life-years (QALYs).

Results In the base case analysis, TARGIT-IORT was a highly cost-effective strategy yielding health gain at a lower cost than its comparator EBRT. Discounted TARGIT-IORT and EBRT costs for the time horizon of 10 years were ¡ê12 455 and ¡ê13 280, respectively. TARGIT-IORT gained 0.18 incremental QALY as the discounted QALYs gained by TARGIT-IORT were 8.15 and by EBRT were 7.97 showing TARGIT-IORT as a dominant strategy over EBRT. Model outputs were robust to one-way and probabilistic sensitivity analyses.

Conclusions TARGIT-IORT is a dominant strategy over EBRT, being less costly and producing higher QALY gain.

Trial registration number [ISRCTN34086741][1]; post results

 [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN3408674
%U https://bmjopen.bmj.com/content/7/8/e014944