Comparing the cost-effectiveness of two brain metastasis treatment modalities from a payer's perspective: Stereotactic radiosurgery versus surgical resection

Objectives: This study aims to identify the cost-effectiveness of two brain metastatic treatment modalities, stereotactic radiosurgery (SRS) versus surgical resection (SR), from the perspective of Germany's Statutory Health Insurance (SHI) System. Methods: Retrospectively reviewing 373 patients with brain metastases (BMs) who underwent SR (n = 113) and SRS (n = 260). Propensity score matching 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. Results: Survival time means of SR and SRS were 13.0, 18.4 months, respectively (P = 0.000). Medians of free brain tumor time were 10.4 months for SR and 13.8 months for SRS (P = 0.003). Number of repeated SRS treatments significantly influenced the survival time of SRS (R² = 0.249; P = 0.006). SRS had a lower average cost per patient (€9964-SD: 1047; Skewness: 7273) than SR (€11647-SD: 1594; Skewness: 0.465), leading to an incremental cost effectiveness ratio of €-3740 per life year saved (LYS), meaning that using SRS costs €1683 less than SR per targeted patient, but increases LYS by 0.45 years. Conclusion: SRS is more cost-effective 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.