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ESTRO 36
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SP-0295 Radiotherapy costs: the good, the bad and the
ugly
L.Perrier
5
Cancer Centre Léon Bérard, Clinical Research and
Innovation Direction, Lyon, France
Abstract not received
OC-0296 A critical quality appraisal of studies
estimating the cost of radiotherapy
N. Defourny
1
, P. Dunscombe
2
, C. Grau
3
, Y. Lievens
4
, L.
Perrier
5
1
ESTRO A.I.S.B.L., HERO, Brussels, Belgium
2
University of Calgary, Department of Oncology, Calgary,
Canada
3
Aarhus University, Department of Clinical Medicine,
Aarhus, Denmark
4
University Hospital Ghent, Radiation Oncologist, Ghent,
Belgium
5
Cancer Centre Léon Bérard, Clinical Research and
Innovation Direction, Lyon, France
Purpose or Objective
In the context of growing healthcare expenses combined
with reduced economic growth, health economics (HE)
studies are becoming paramount. Considerable interest in
the domain is apparent when looking at the number of
articles indexed with HE keywords. Nevertheless, a recent
literature review has revealed very few articles
calculating the cost of radiotherapy, and a large
heterogeneity in the methodologies used. The aim of this
complementary review is to report on existing guidance in
HE and to critically assess guideline compliance in the
radiotherapy literature.
Material and Methods
A systematic literature review of cost computation studies
in external photon beam radiation therapy (EBRT) from
1981-2015 was recently conducted by us. Building on this
earlier work, existing HE guidelines have been reviewed
and a list of relevant items for cost estimations has been
compiled. The guidelines searched were ISPOR’s Good
Practices For Outcome Research guidelines, HE evaluation
quality appraisal instruments and National guidelines
(EUnetHTA). A standardised framework focusing on
recommendations on cost assessment was designed with
the help of these guidelines. Fifty-two HE studies meeting
criteria established in our earlier literature review were
studied in-depth: cost assessment methods, descriptions
of methodologies (e.g. sample size, time horizon, or
discounting clearly mentioned), and relevant statistical
analyses performed (e.g. selection bias treated,
sensitivity analyses done) were all critically appraised
within the framework.
Results
Guidance on HE analyses is often provided in the form of
a checklist of items to be addressed. Direction on the cost
type to estimate, the analysis to conduct, and methods for
tackling uncertainty of data are outlined, e.g. ‘’identify
relevant cost for each alternative and value the cost
appropriately’’. Evaluation of the 52 studies against
published HE recommendations revealed shortcomings in
the cost assessment methodologies, the implications of
that choice, and the calculation methods used.
Among selected studies, heterogeneity was observed in
the quantity and quality of the information disclosed.
While documentation of cost items and sample size was
found in 67% of the 52 articles, and the reference year of
cost data was present in 85%, only 37% of the articles
specified data sources used by the authors, 35% stated
their discounting methods and just 8% mentioned the
study’s time horizon. Descriptive statistics analyses were
present in 35% of the studies and uncertainty treatment in
48%.
Conclusion
Existing guidance on formulating the cost part of HE
evaluation studies establishes an outline framework while
giving researchers a high degree of freedom. The limited
number of studies investigating the cost of EBRT do not
systematically follow these published HE guidance leaving
room for quality improvement in this increasingly
influential research area.
SP-0297 Method of development of ESMO Magnitude of
Clinical Benefit applicable for radiotherapy?
E.G.E. De Vries
1
, R. Sullivan
2
, N.I. Cherny
3
1
UMCG University Medical Center Groningen,
Department of Medical Oncology, Groningen, The
Netherlands
2
Institute of Cancer Policy, Kings Health Partners
Integrated Cancer Centre- King's College London,
London, United Kingdom
3
Shaare Zedek Medical Center, Cancer Pain and Palliative
Medicine Service- Department of Medical Oncology,
Jerusalem, Israel
The value of any new therapeutic strategy or treatment is
determined by the magnitude of its clinical benefit
balanced against its cost. Evidence for clinical benefit
from new treatment options is derived from clinical
research, in particular phase III randomised trials, which
generate unbiased data regarding the efficacy, benefit
and safety of new therapeutic approaches. Until recently,
there was no standard tool for grading the magnitude of
clinical benefit of cancer therapies, which may range from
trivial (median progression-free survival advantage of only
a few weeks) to substantial (improved long-term survival).
Indeed, in the absence of a standardised approach for
grading the magnitude of clinical benefit, conclusions and
recommendations derived from studies are often hotly
disputed and very modest incremental advances have
often been presented, discussed and promoted as major
advances or 'breakthroughs'. Recognising the importance
of presenting clear and unbiased statements regarding the
magnitude of the clinical benefit from new therapeutic
approaches derived from high-quality clinical trials, the
European Society for Medical Oncology (ESMO) has
developed a validated and reproducible tool to assess the
magnitude of clinical benefit for cancer medicines, the
ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS).
An ESMO Task Force to guide the development of the
grading scale was established in March 2013. A first-
generation draft scale was developed and adapted through
a ‘snowball’ method based upon previous work of Task
Force members who had independently developed
preliminary models of clinical benefit grading. The first-
generation scale was sent for review by 276 members of
the ESMO faculty and a team of 51 expert biostatisticians.
The second-generation draft was formulated based on the
feedback from faculty and biostatisticians and the
conceptual work of Alberto Sobrero regarding the
integration of both hazard ratio (HR), prognosis and
absolute differences in data interpretation [J Clin Oncol
2009, Clin Cancer Res 2015]. The second-generation draft
was applied in a wide range of contemporary and historical
disease settings by members of the ESMO-MCBS Task
Force, the ESMO Guidelines Committee and a range of
invited experts. Results were scrutinized for face validity,
coherence and consistency. Where deficiencies were
observed or reported, targeted modifications were
implemented and the process of field testing and review
was repeated. This process was repeated through 13
redrafts of the scale preceding the current one (ESMO-
MCBS v1.0). The final version and fielded testing results
were reviewed by selected members of the ESMO faculty
and the ESMO Executive Board. Version 1.0 appeared in
2015 (Cherny et al. Ann Oncol).
This tool thus provides a rational, structured and
consistent approach to derive a relative ranking of the
magnitude of clinically meaningful benefit that can be