Do we need cost-effectiveness analysis of brachytherapy for cervical cancer in the 3D image-guided era?

Abstract

Cervical cancer is the second most prevalent cancer in the female population. Intracavitary brachytherapy is considered an essential component of the disease management. In conventional brachytherapy, treatment planning is performed using X-ray imaging to visualize the pelvic bones structures and applicators, considering point A as the reference for dose delivery. For the last years, three-dimensional (3D) image-guided brachytherapy, with the use of computed tomography or magnetic resonance imaging, has been used to determine tumor volume and shape, as well as the healthy organs at risk, and prescribed dose is delivered to an ‘at-risk’ volume. Although 3D brachytherapy shows technical advantage and potentially superior clinical outcomes over conventional, 3D planning does carry added costs. The decision about incorporating new health technologies in health care systems should be based in multiple aspects, including financial issues. Economic evaluation studies have been adopted as a method for supporting efficient resource allocation. Cost-effectiveness analysis, in particular assessing consequences as quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs), that is cost-utility analysis, are the preferred type of economic evaluation study for decision-making on technology incorporation. Evidence from economic evaluation studies are not transferrable to other health care systems with distinct health policies, resources and priorities, therefore, whether the benefits afforded by 3D brachytherapy are cost-effective is to be determined withing each health care system considering local context.