Value of Money in Cancer — IMRT as

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: A costs $1 million Life § How much does something cost? § What do we get for what we pay? § Cost-effectiveness analysis B costs $1 million Life

Value for money in Cancer 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. 3 D-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 0. 000 QALYs gained (discounted at 5%) 6. 085 6. 062 0. 023 Incremental cost per QALY gained $26, 768 Total cost (discounted at 5%)

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. 2 D-RT in head and neck cancers § Compared with 2 D-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 Value for money in Cancer 313 studies (2004 -2010) Data: The Center for Evaluation of Value and Risk in Health, CEA Registry Diagnosis 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 Mc. Gowan and Murray Krahn § IMRT Indications Expert Panel § Drs. Brian O’Sullivan and Glenn Bauman Ontario Ministry of Health and Long-Term Care

Jean. yong@cancercare. on. ca 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