OBJECTIVES: To provide information on the 1) cost methodology and main cost components used in economic evaluations of brachytherapy (BT) in patients with cervical cancer, and 2) model characteristics and main results in full economic evaluations comparing three-dimensional (3D) BT over conventional (2D) BT in that population.

METHODS: We searchead 18 databases for partial economic evaluations reporting 3DBT and/or 2DBT among the resources used to treat patients with cervical cancer, or full economic evaluations comparing 3DBT over 2DBT. No language or publication date restrictions were used. Study selection, appraisal and data extraction were performed independently by two reviewers. Cost estimates were converted to US dollars (US$) in 2022 using Purchasing Power Parities. We used narrative summaries to present the results.

RESULTS: The search yielded 1907 publications, of which 11 were included, representing two full economic evaluations with cost-utility analyses and nine partial evaluations. Eight studies were conducted from the payer’s and two from the provider´s perspective. The mean cost of 3DBT strategy varied from US$3754 to US$31,305 and 2DBT from US$467 to US$20,172. Differences in costs were driven by variations in cost methodologies and cost components. Costs of equipment acquisition were reported by two and personnel costs by eight studies. The two full economic evaluations applied a Markov state-transition model, with simplifications in the course of the disease, particularly about treatment harms. There were differences in Markov cycle lengths, analytic time horizons and health states considered. The transitions probabilities were based on non-systematically reviewed literature and expert opinion. In both modeling studies, 3DBT was dominant or cost-effective.

CONCLUSIONS: The economic evaluations have adopted varied resources to account for costs, resulting in substantially different mean BT costs. 3DBT was cost-effective in both identified full economic evaluations, however, there is considerably source of parameter and structural uncertainty in these models.