COST-BENEFIT ANALYSIS OF TUMOR TREATING FIELDS PLUS RADIOSURGERY FOR BRAIN METASTASES FROM NON-SMALL CELL LUNG CANCER
Author(s)
Greg Guzauskas, MSPH, PhD1, Jorge F. Nino de Rivera Guzman, MSc2, Bruce Wang, PhD3.
1The CHOICE Institute, Orcas, WA, USA, 2Health Economy specialist, Novocure, Glendale, CO, USA, 3Elysia Group, LLC, New York, NY, USA.
1The CHOICE Institute, Orcas, WA, USA, 2Health Economy specialist, Novocure, Glendale, CO, USA, 3Elysia Group, LLC, New York, NY, USA.
OBJECTIVES: Evaluate the cost-benefit of adding Tumor Treating Fields (TTFields) to stereotactic radiosurgery (SRS) for patients with 1-10 brain metastases stemming from non-small cell lung cancer (NSCLC. The analysis was informed by the METIS phase 3 trial, which compared TTFields+SRS with SRS alone.
METHODS: A three-state Markov model (stable intracranial disease, intracranial progression, death) was developed from a US payer perspective with monthly cycles and a lifetime horizon. Transition probabilities for intracranial progression were derived from METIS 12- and 24-month outcomes using a piecewise hazard structure. Mortality was assumed equivalent across arms due to the absence of an overall-survival difference in METIS. Costs (2025 USD) included TTFields device costs, salvage therapy, supportive care, and end-of-life care. Intracranial progression was the primary driver of cost differences. Outcomes included total costs, IC control time, cost per additional IC control (year, month, week, day), and average cost-effectiveness (ACER). A probabilistic sensitivity analysis (PSA) with 5,000 simulations was performed.
RESULTS: TTFields+SRS increased lifetime costs relative to SRS alone ($122,403 vs $61,810). However, TTFields yielded more intracranial control time, reducing costly progression-related care. The average cost for intracranial control was $468,079 per additional year, $39,007 per additional month, $8,971 per additional week, and $1,282 per additional day. The ACER was $145,797 (95% credible range: $118,399 to $199,859). TTFields also reduced the expected need for expensive salvage therapies, including repeat SRS and whole brain radiotherapy. PSA demonstrated wide uncertainty in model outcomes but consistently showed health benefits for TTFields due to increased intracranial control.
CONCLUSIONS: Adding TTFields to SRS increases payer spending but provides additional intracranial disease control and reduces the need for salvage interventions. When expressed as cost per additional IC control, TTFields demonstrates a quantifiable and policy-relevant benefit for a population with high unmet need and limited durable treatment options.
METHODS: A three-state Markov model (stable intracranial disease, intracranial progression, death) was developed from a US payer perspective with monthly cycles and a lifetime horizon. Transition probabilities for intracranial progression were derived from METIS 12- and 24-month outcomes using a piecewise hazard structure. Mortality was assumed equivalent across arms due to the absence of an overall-survival difference in METIS. Costs (2025 USD) included TTFields device costs, salvage therapy, supportive care, and end-of-life care. Intracranial progression was the primary driver of cost differences. Outcomes included total costs, IC control time, cost per additional IC control (year, month, week, day), and average cost-effectiveness (ACER). A probabilistic sensitivity analysis (PSA) with 5,000 simulations was performed.
RESULTS: TTFields+SRS increased lifetime costs relative to SRS alone ($122,403 vs $61,810). However, TTFields yielded more intracranial control time, reducing costly progression-related care. The average cost for intracranial control was $468,079 per additional year, $39,007 per additional month, $8,971 per additional week, and $1,282 per additional day. The ACER was $145,797 (95% credible range: $118,399 to $199,859). TTFields also reduced the expected need for expensive salvage therapies, including repeat SRS and whole brain radiotherapy. PSA demonstrated wide uncertainty in model outcomes but consistently showed health benefits for TTFields due to increased intracranial control.
CONCLUSIONS: Adding TTFields to SRS increases payer spending but provides additional intracranial disease control and reduces the need for salvage interventions. When expressed as cost per additional IC control, TTFields demonstrates a quantifiable and policy-relevant benefit for a population with high unmet need and limited durable treatment options.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE364
Topic
Economic Evaluation
Disease
SDC: Oncology