OBJECTIVES

: To determine if in patients with refractory pain from bone metastases, if palliation with magnetic resonance guided focused ultrasound (MRgFUS), a novel non-invasive ablation technique, compared to medication alone, is cost-effective (incremental cost-effectiveness ratio or ICER), for a 24-month time horizon, from a health system perspective.

METHODS

: We constructed a Markov state transition model using TreeAgePro®. Probabilities, costs, and effectiveness data were derived from a combination of the available literature, expert opinion, and reimbursement data at two U.S. medical centers performing MRgFUS. In the model, costs and quality adjusted life years (QALYs), discounted at a rate of 3%/year, were accumulated each month over a 24-month time horizon. Willingness-to-pay level was estimated at $100,000/QALY. Multiple sensitivity analyses were performed.

RESULTS

: In the base case analysis, MRgFUS cost an additional $8756.23 per 0.22 QALYs, equal to a $40150/QALY ICER, making MRgFUS the preferred strategy. 1-way sensitivity analyses showed that the crossover point at which Medication Only would become the preferred strategy was an MRgFUS cost of $25,711.58. If, in the base case, the costs of background medication for patients with relief of MRgHIFU is increased from 25% to 50% of baseline pain medication usage, the ICER increases from $40150.20/QALY to $45,011.00/QALY with a new crossover point established at an MRgFUS cost of $24,841.62 per treatment. Additionally, if the percentage of patients repeating MRgFUS increases from 50 to 100%, the ICER increases slightly to $40239.81/QALY.

CONCLUSIONS

: Our base case and sensitivity analyses demonstrated that MRgFUS was a preferred treatment strategy across a wide range of transition state probabilities, costs, and QALYs. Our model was most sensitive to changes in the cost of MRgFUS and QALYs associated with persistent pain or pain relief.