The cost-effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of brain metastasis in Vietnam from the perspective of patients and families.

Abstract

This study aims to evaluate the cost-effectiveness of the treatment of brain metastasis with surgical resection (SR) and stereotactic radiosurgery (SRS) in the lower-middle-income country of Vietnam from the perspective of patients and families. The treatment of 111 patients with brain metastases who underwent SR (n = 64) and SRS (n = 47) was retrospectively reviewed. Propensity score matching was used to adjust for selection bias (n = 30 each); mean and curves of survival time were defined by the Kaplan-Meier estimator; the cost analysis focused on the time period of relevant treatment. The mean survival times of SRS and SR were 11.9 and 10.5 months, and the 18-month survival rates were 32% and 14%, respectively (P = 0.346). The mean number of hospital bed days was significantly higher for SR than SRS (16.5 versus 7.6 days, P < 0.05), but direct costs of SR were significantly lower (14.5 as opposed to 35.3 million Vietnamese dong [VND] per patient, P < 0.001). However, indirect costs of SR were 10 times higher (26.0 versus 2.5 million VND per patient, P < 0.001). The cost per life year gained was higher for SR than SRS (46.4 and 38.1 million VND, respectively). SRS is similarly effective as SR. However, in the broader context of the cost-effectiveness from the perspective of patients and their families, SRS is more cost-effective. The lower costs directly charged by the hospital for SR may prevent poorer and older patients from choosing SRS. Thus, the overall cost-effectiveness of each treatment option should be taken into consideration in deciding on the treatment.