Analytical approach:
A decision-analytic state transition Markov model was used to synthesise data from several studies identified from the published literature. The time horizon of the analysis was a lifetime time horizon. The study perspective was that of the payer (Medicare).
Effectiveness data:
Effectiveness data were derived from published studies and included a long-term follow-up study from a phase II trial and long-term observational studies. The main clinical effectiveness estimates were local control and recurrence rates of cancer derived from several published studies.
Monetary benefit and utility valuations:
Utility valuations were taken from a single study from the published literature that elicited utility values from patients with non-small cell lung cancer.
Measure of benefit:
Quality adjusted life years (QALYs) discounted at an annual rate of 3%.
Cost data:
Costs of events following treatment with SBRT, radiofrequency ablation or 3D-CRT and included the cost of treatment for pneumothorax, pnuemonitis and chest wall pain, cost of chest CT (computed tomography) scans, palliative care and non-cancer end-of-life care. Resource use and prices were based on 2009 Medicare schedules, a published Medicare based study, the Red Book and Diagnosis Related Group reimbursement. Costs were presented in 2009 US Dollars ($) and discounted at an annual rate of 3%.
Analysis of uncertainty:
One-way, two-way and probabilistic sensitivity analysis were undertaken. Results were presented in tables and a cost-effectiveness acceptability curve.