Cost-effectiveness of prophylactic cranial irradiation in stage III non-small cell lung cancer - PDF Version

Willem J.A. Witlox, Bram L.T. Ramaekers, Benjamin Lacas, Cecile Le Pechoux, Alexander Sun, Si-Yu Wang, Chen Hu, Mary Redman, Vincent van der Noort, Ning Li, Matthias Guckenberger, Harm van Tinteren, Lizza E.L. Hendriks, Harry J.M. Groen, Manuela A. Joore, Dirk K.M. De Ruysscher

Radiother Oncol. March 04, 2022, DOI: 


In stage III non-small cell lung cancer (NSCLC), prophylactic cranial irradiation (PCI) reduces the brain metastases incidence and prolongs the progression-free survival without improving overall survival. PCI increases the risk of toxicity and is currently not adopted in routine care. Our objective was to assess the cost-effectiveness of PCI compared with no PCI in stage III NSCLC from a Dutch societal perspective.


A cohort partitioned survival model was developed based on individual patient data from three randomised phase III trials (N=670). Quality-adjusted life years (QALYs) and costs were estimated over a lifetime time horizon.. A willingness-to-pay (WTP) threshold of €80,000 per QALY was adopted. Sensitivity and scenario analyses were performed to address parameter uncertainty and to explore what parameters had the greatest impact on the cost-effectiveness results.


PCI was more effective and costly (0.443 QALYs, €10,123) than no PCI, resulting in an incremental cost-effectiveness ratio (ICER) of €22,843 per QALY gained. The probability of PCI being cost-effective at a WTP threshold of €80,000 per QALY was 93%. The probability of PCI gaining three and six additional months of life were 76% and 56%. The scenario analysis adding durvalumab increased the ICER to €35,159 per QALY gained. Using alternative survival distributions had little impact on the ICER. Assuming fewer PCI fractions and excluding indirect costs decreased the ICER to €18,263 and €5,554 per QALY gained.


PCI is cost-effective compared to no PCI in stage III NSCLC, and could therefore, from a cost-effectiveness perspective, be considered in routine care.