Cost-effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of brain metastasis with German statutory health insurance perspective

Keywords: gamma knife, brain metastasis, cost effectiveness, resection, outcome

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     The cost and value of brain metastasis care is important.
This study aims to identify the cost-effectiveness of two treatment modalities for the treatment of brain metastases, stereotactic radiosurgery (SRS) versus surgical resection in combination with whole brain Radiotherapy (SR), from the perspective of Germany''s Statutory Health Insurance (SHI) System.
     373 patients were studied after radiosurgery or resection.
     Retrospectively reviewing 373 patients with brain metastases (BMs) who underwent SR (n=113) and SRS (n=260). Propensity score matching (PSM) was used to adjust for selection bias (n=98 each); means of survival time and survival curves were defined by the Kaplan-Meier estimator; and medical costs of follow-up treatment were calculated by the Direct (Lin) method. The bootstrap resampling technique was used to assess the impact of uncertainty.
     Survival time means of SR and SRS were 13.0, 18.4 months, respectively (P=.000). Medians of free brain tumor time were 10.4 months for SR compared to 13.8 months for SRS (P=0.003). Number of repeated SRS treatments significantly influenced the survival time of SRS patients (R2 =.249; p=.006). SRS had a lower average cost per patient (€7212 - SD: 1047; Skewness: 7273) than those of SR (€10964 - SD: 1594; Skewness: 0.465), leading to an incremental cost effective ratio of (ICER) €-8338 per life year saved (LYS), meaning that using SRS costs €3752 less than SR per targeted patient, but increases LYS by 0.45 years.
     This was a retrospective analysis.
     SRS is definitely a more cost-effective treatment than SR in the treatment of brain metastasis (BM) from the SHI perspective.
     When the clinical conditions allow it, early intervention with SRS in new BM cases and frequent SRS repetition in new BM recurrent cases should be advised.


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