Table 5.
Literature review for previous studies that compared cost-utility between radiotherapy alone and combined surgery (Sx) and radiotherapy (RT) for spinal metastasis
| Variable | Furlan et al.8 2012 | Miyazaki et al.2 2017 | Turner et al.10 2018 | Depreitere et al.7 2019 | Schoenfeld et al.9 2021 | The present study |
|---|---|---|---|---|---|---|
| Data collection year | Jan 2001–July 2005 | 2010–2014 | 2009–2015 | 2011–2015 | 2005–2017 | 2018–2020 |
| Perspective | Public | Public | Societal | Societal | Health system | Societal |
| Country | Canada | Japan | United Kingdom | Belgium | United States | Thailand |
| Patient data | 101 (50 Sx, 51 RT) | 47 (31 Sx, 16 RT) | 100 (50 Sx, 51 RT) | 46 (38 Sx, 8 RT) | 713 (370 Sx, 343 RT) | 24 (12 Sx, 12 RT) |
| Primary tumor | Surgery group | Surgery group | -Breast 14 (14.7%) | Surgery group | - | Surgery group |
| -Lung 13/50 | -Lungs 8 (25.8%) | -Prostate 13 (13.7%) | -Breast (15.8%) | -Lung (33.3%) | ||
| -Prostate 9/50 | -Sarcoma 6 (19.3%) | -Renal 10 (10.5%) | -Gastric and lung (10.5%) | -Breast and prostate (16.7%) | ||
| Radiation group | Radiation group | Radiation group | Radiation group | |||
| -Lung 13/50 | -Kidney 4 (25%) | -Breast (50%) | -Breast (33.3%) | |||
| -Prostate 10/50 | -Sarcoma 3 (18.7%) | -Lung (25%) | ||||
| Cost | Surgery group | Surgery group | Surgery group | Surgery group | Independent ambulatory status at presentation | Surgery group |
| Mean overall costs: 583,809.21 USD (95% CI, 61,813.80–2,235,090.76) | Total medical cost: 25,770±7,750 USD | -The median community tariff: 38,802 pounds (IQR, 13,085–83,893) | -The median total cost of treatment 15,462 EUR (IQR, 10,911–23,116, mean 16,989 EUR, SD 8,148 EUR) | -Nonoperative treatment: 53,299 USD | -Total cost: 59,859.95 USD | |
| Radiation group | Radiation group | Radiation group | Radiation group | -Operative treatment: 73,777 USD | Radiation group | |
| Mean overall costs: 554,323.01 USD (95% CI, 59,407.05–2,211,295.22) | Total medical cost: 8,615±12,273 USD | -The median total tariff: 45,141 pounds (IQR, 19,423–90,231) | -The mean total cost: 9,354 EUR | Nonambulatory status at presentation | -Total cost: 24,525.45 USD | |
| -Nonoperative treatment: 38,330 USD | ||||||
| -Operative treatment: 73,481 USD | ||||||
| Utility assessment | - | 1 Year | Mean follow-up: 24.8 months | 24 Months | 12 Months | 6 Months |
| (SD 11.8) | ||||||
| Utility result | ||||||
| Sx | - | 0.448 ± 0.451 | - | - | - | 0.80 ± 0.26 |
| RT | - | 0.019 ± 0.027 | - | - | - | 0.52 ± 0.28 |
| QALY | ||||||
| Sx | 0.57 (95% CI, 0.13–2.24) | 0.433 ± 0.327 | Median 0.28 (IQR, 0.04–0.99) | Median postoperative QALY 070 (IQR, 0.18–1.70; mean, 0.95; SD, 0.96) | -Independent ambulatory status 0.823 | 1.54 |
| Mean 0.64 (SD, 0.76) | -Nonambulatory status 0.813 | |||||
| RT | 0.46 (95% CI, 0.06–3.14) | 0.024 ± 0.028 | Median 0.13 (IQR, 0.02–0.50) | Median QALY 0.17 (IQR, 0.01–0.56; mean, 0.42; SD, 0.64) in QALY overestimation, and 0.01 (IQR, 0.01–0.35; mean, 0.26; SD, 0.36) in QALY underestimation scenario | -Independent ambulatory status 0.800 | 0.92 |
| Mean 0.32 (SD, 0.45) | -Nonambulatory status 0.089 | |||||
| ICER | 250,307.30 USD/QALY | 42,003 USD/QALY | - | 13,635 EUR/QALY | -Independent ambulatory status 899,700 USD | US 57,071.31 USD/QALY |
| -Nonambulatory status 48,600 USD | ||||||
| Willingness-to-pay per QALY | 50,000 USD | 50,000 USD | - | 37,300 EUR | 100,000–150,000 USD | 5,113 USD (160,000 THB) |
| Exchange rates | 2010 USD | 2014 USD | 2015–2016 financial year | 2015–2016 financial year | 2019 USD | 2020 USD |
USD, United States dollar; EUR, euro; IQR, interquartile range; QALY, quality-adjusted life-year; ICER, incremental cost-effectiveness ratio.