In a substantial development towards enhancing the quality and cost-effectiveness of palliative care for cancer patients, a groundbreaking study titled “An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared with Conventional Palliative RT for Spinal Metastases” has been published in the “International Journal of Radiation Oncology, Biology, Physics” (DOI: 10.1016/j.ijrobp.2023.12.052).

This multicenter randomized controlled phase 2/3 trial, conducted across Canada and Australia, with primary author Dr. Marc M. Kerba from the University of Calgary, and colleagues, has poised itself at the forefront of transforming how spinal metastases pain is managed using radiotherapy protocols. The trial set out to provide empirical evidence on health economics related to two fundamentally different radiotherapy techniques—stereotactic body radiotherapy (SBRT) and conventional external beam radiotherapy (CRT).

Methodology

The trial enrolled 229 patients suffering from painful spinal metastases, a condition where cancer cells spread to the bones of the vertebral column, causing debilitating pain. The participants were randomized to receive either a shorter course of high-dose SBRT at 24 Gy in 2 sessions or a longer regimen of CRT at 20 Gy in 5 sessions. Dr. Arjun Sahgal, a contributing researcher from the University of Toronto, emphasized the study’s commitment to assessing treatments’ impact on both pain control and economic ramifications.

Findings

Key findings indicated a superior complete pain response rate (CRR) at 3 months for SBRT recipients (35%) as compared to those who underwent CRT (14%). Even though SBRT planning and delivery demand more resources, the team, including experts like Dr. Shankar Siva, from the University of Melbourne, deliberated on its economic justification considering its higher upfront costs.

The Economic Analysis

The paper, notably contributed by health economists like Richard De Abreu Lourenco and Rafael de Feria Cardet from the University of Technology Sydney, detailed a Markov model-based cost-effectiveness study. Valuation of patients’ quality of life (QoL) was carried out through the EORTC-QLU-C10D metric, and health system costs were calculated from the perspective of Canadian healthcare expenses, reflecting 2021 Canadian dollars.

The headline result of this analysis was that SBRT had an incremental cost-effectiveness ratio (ICER) of $9,040 CDN per quality-adjusted life year (QALY) gained relative to CRT—a figure within acceptable limits of healthcare interventions in Canada. This finding illustrates SBRT’s overall value, integrating treatment efficacy with health-economic outcomes.

Response and Sensitivity to Variations

Further inspection by the authors, including Drs. Keyue Ding and Sten Myrehaug, found the ICER was most affected by fluctuation of the utility value assigned to ‘No local failure’ status of the patients and the actual costs of SBRT equipment and procedures. Less susceptible were components such as survival rates and response rates.

Implications for Policy and Practice

The study has considerable implications for clinical practice and policy-making in the healthcare system. As Dr. Giuseppina L. Masucci, a collaborator from Montreal, mentioned, “The higher initial investment in SBRT is likely to be offset by its long-term benefits.” The robust economic analysis suggests that Canadian healthcare administrators can feel more confident in supporting the adoption of SBRT as a cost-effective treatment.

These profound conclusions, supported by Michael Brundage and Wendy R. Parulekar from Queen’s University, contribute to a pivotal moment in cancer care, potentially influencing future guidelines and reimbursement policies.

Limitations and Future Research

While the study offers a compelling case for SBRT use, certain limitations are acknowledged. These include the need to consider broader societal costs and the study’s generalizability beyond Canadian and Australian healthcare systems. Going forward, Dr. Kerba and his team encourage ongoing evaluation of cost-effectiveness as technology evolves and new data becomes available.

Keywords

1. Stereotactic Body Radiotherapy (SBRT) Cost-Effectiveness
2. Spinal Metastases Treatment Economy
3. Palliative Radiotherapy Canada
4. Quality-Adjusted Life Year (QALY) Radiotherapy
5. SBRT vs CRT Economic Analysis

References

1. Kerba MM, et al. An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared with Conventional Palliative RT for Spinal Metastases. Int J Radiat Oncol Biol Phys. 2024;S0360-3016(24)00022-1. doi:10.1016/j.ijrobp.2023.12.052.
2. Sahgal A, et al. Stereotactic Body Radiotherapy for Spinal Metastases: Current Status, with a Focus on its Application in the Postoperative Patient. J Clin Oncol. 2011;29(11):1478-1484.
3. Chow E, et al. Update on the Systematic Review of Palliative Radiotherapy Trials for Bone Metastases. Clin Oncol (R Coll Radiol). 2012;24(2):112-124.
4. Fowler JF. The Radiobiology of Prostate Cancer Including New Aspects of Fractionated Radiotherapy. Acta Oncologica. 2005;44(3):265-276.
5. Gagnon B, et al. Cost Utility of Stereotactic Body Radiotherapy versus Surgical Management for Operable Stage I Non-Small-Cell Lung Cancer. J Thorac Oncol. 2015;10(4):737-744.