Less is not Always More: An Economic Analysis of Radiation Therapy Oncology Group 9410

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Less is not Always More An Economic Analysis
of Radiation Therapy Oncology Group 94-10

• Andre Konski, MD, MBA, MA FACR for
• Mythreyi Bhargavan PhD, Jean Owen PhD, Ritsuko
  Komaki MD, Corey Langer MD , Roger Byhardt MD,
  Rebecca Paulus MS, Hak Choy MD, Deborah
  Watkins-Bruner RN, PhD,
• Walter Curran MD

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• The objective of this study was to determine the
  cost-effectiveness of 3 different treatments for
  locally advanced non-small cell lung cancer using
  Medicare data

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RTOG 94-10

• Arm 1
• Vinblastine 5 mg/m2 i.v. bolus weekly first 5
  weeks
• Cisplatin 100 mg/m2 iv over 30-60 minutes, day 1
  29
• RT 63 Gy/7 weeks/34 fractions (1.8 Gy x 25 then
  2 Gy x 9) beginning day 50
• Arm 2
• Vinblastine 5 mg/m2 i.v. bolus weekly first 5
  weeks
• Cisplatin 100 mg/m2 iv over 30-60 minutes, day 1
  29
• RT 63 Gy/7 weeks/34 fractions (1.8 Gy x 25 then
  2 Gy x 9) beginning day 1
• Arm 3
• Oral VP-16/ 50 mg bid x 10 only on RT days 1-5,
  8-12, 29-33, and 36-40
• Cisplatin 50 mg/m2 iv over 30-60 minutes on day 1
  and 8 and 29 and 36
• RT 69.6 Gy/6 weeks/58 x 1.2 Gy bid beginning day
  1

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Incremental Cost-effectiveness comparing
induction chemotherapy and hyperfractionated
radiotherapy to standard chemoradiation
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Conclusion

• Induction chemotherapy and radiation was the
  least costly treatment compared standard
  radiotherapy or hyperfractionated radiotherapy
  occurring because the treatment was less
  effective. Treatment decisions based on cost
  from administrative databases can be misleading
  unless combined with outcome data in formal
  cost-effectiveness analyses.