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Cost-effectiveness analysis of magnetic resonance-guided focused ultrasound ablation for palliation of refractory painful bone metastases

Published online by Cambridge University Press:  03 December 2020

Matthew D. Bucknor Open the ORCID record for Matthew D. Bucknor [Opens in a new window] ,
Frandics P. Chan ,
Jessica Y. Matuoka ,
Patti K. Curl  and
James G. Kahn
Matthew D. Bucknor*
Affiliation:
Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
Frandics P. Chan
Affiliation:
Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
Jessica Y. Matuoka
Affiliation:
Departamento de Enfermagem Médico-Circúrgica, University of São Paulo, Rua de Reitoria, 374, São Paoulo 05508-010, SP, Brazil
Patti K. Curl
Affiliation:
Department of Radiology, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA
James G. Kahn
Affiliation:
Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
*
Author for correspondence: Matthew D. Bucknor, E-mail: matthew.bucknor@ucsf.edu
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Abstract

Objective

The aim of this study was to determine if magnetic resonance-guided focused ultrasound (MRgFUS) is cost-effective compared with medication, for refractory pain from bone metastases in the United States.

Methods

We constructed a Markov state transition model using TreeAge Pro software (TreeAge Software, Inc., Williamstown, MA, USA) to model costs, outcomes, and the cost-effectiveness of a treatment strategy using MRgFUS for palliative treatment of painful bone metastases compared with a Medication Only strategy (Figure 1). Model transition state probabilities, costs (in 2018 US$), and effectiveness data (quality-adjusted life-years [QALYs]) were derived from available literature, local expert opinion, and reimbursement patterns at two U.S. tertiary academic medical centers actively performing MRgFUS. Costs and QALYs, discounted at three percent per year, were accumulated each month over a 24-month time horizon. One-way and probabilistic sensitivity analyses were performed.

Results

In the base-case analysis, the MRgFUS treatment strategy costs an additional $11,863 over the 2-year time horizon to accumulate additional 0.22 QALYs, equal to a $54,160/QALY ICER, thus making MRgFUS the preferred strategy. One-way sensitivity analyses demonstrate that for the base-case analysis, the crossover point at which Medication Only would instead become the preferred strategy is $23,341 per treatment. Probabilistic sensitivity analyses demonstrate that 67 percent of model iterations supported the conclusion of the base case.

Conclusions

Our model demonstrates that MRgFUS is cost-effective compared with Medication Only for palliation of painful bone metastases for patients with medically refractory metastatic bone pain across a range of sensitivity analyses.

Keywords

Magnetic resonance-guided focused ultrasound (MRgFUS)High-intensity focused ultrasoundThermal ablationBone metastases
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 37 , Issue 1 , 2021 , e30
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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