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Publications (2)2.21 Total impact

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    ABSTRACT: In this study, we compare 2 treatment options and determine cost-effectiveness and cost-utility. We carried out a decision analysis populated with data from patients with brain metastasis in a concurrent trial randomized to either stereotactic radiosurgery (SRS) and observation or SRS and whole brain radiation therapy. Outcomes included actual life years saved (LYS), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Costs used were from the healthcare perspective and utilities were captured through a time-trade-off method, using 10-year, 5-year, and 1-year time horizons. One-way sensitivity analyses were carried out to determine robustness of the decision analysis model. Compared with SRS and whole brain radiation therapy, SRS and observation not only had a higher average cost ($74,000 vs $119,000, respectively) but also a higher average effectiveness (0.60 LYS vs 1.64 LYS, respectively) with an ICER of $44,231/LYS or $41,783/QALY (with utilities captured using a 10-year horizon). Slightly higher ICER estimates were achieved with utilities captured using the other time horizons ($43,280/QALY and $44,064/QALY, respectively). Sensitivity analysis showed that the following variables had the highest impact on the ICER: probability of no recurrence in recursive-partitioning analysis class 2 after SRS and observation; probability of being alive after SRS and observation in recursive-partitioning analysis class 2 and being treated for recurrence. Compared with other interventions in the $50,000 to $100,000/QALY cost-effectiveness range, the application of SRS and observation, with subsequent neurosurgical management of recurrences, is shown to be a reasonable treatment modality for brain metastases.
    American journal of clinical oncology 02/2011; 35(1):45-50. · 2.21 Impact Factor
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    ABSTRACT: Purpose: Study utilized a time-trade-off (TTO) technique to elicit patient preferences for management of brain metastases in patients randomized to whole brain radiation treatment plus stereotactic radiosurgery (SW arm) versus stereotactic radiosurgery alone (SA arm). Method: A TTO instrument with three time horizons (10, 5 , and 1-year) was developed to determine the time a patient is willing to trade off current health for a period of perfect health. Utilities were collected at baseline and predetermined intervals for 2 years. The utilities for baseline and the final visit (last visit prior to death or at end of study) were analyzed to determine if there were any differences based on treatment group and other co-variates, including demographics and medical history, using t-test and linear regression. Result: The study population consisted of 58 patients, 30 (51.72%) male, 46 (79.31%) Caucasian, and mean age of 61.76 (SD: 10.99). There were 27 patients in the SW arm and 31 in the SA arm and the mean baseline utilities were 0.78 (SD: 0.29), 0.83 (SD: 0.27), and 0.88 (SD: 0.26), for the 10-year, 5-year, and 1-year timeframes respectively; the mean final utilities were 0.74 (SD: 0.33), 0.83 (SD: 0.28); and 0.87 (SD: 0.28), respectively. For the 58 patients, there was a stronger correlation between the 10-year and 5-year baseline utilities (R-squared: 0.80) and the 10-year and 5-year final utilities (R-squared: 0.70) than between the 10-year and 1-year (R-squared: 0.48 and 0.56) and the 5-year and 1-year utilities (R-squared: 0.58 and 0.69). Also, there was significant difference in the 10-year versus 5-year baseline and 10-year versus 5-year final utilities (p=0.0041; p=0.0003), the 10-year versus 1-year baseline and final utilities (p=0.0009; p<0.0001) and the 5-year versus 1-year at baseline only (p=0.0411). These data indicate that patients were adjusting the answers to the timeframe presented and the range of time traded was least in the 1-year timeframe. None of the co-variates tested resulted in a positive association, including the treatment group assignment. Conclusion: Patients undergoing radiation treatment for brain metastases do not exhibit differences in preferences to treatment assignment. However, they adjust their responses to the timeframe presented, indicating the validity of using a TTO instrument with different timeframes to elicit utilities in a terminal ill study group.
    The 31th Annual Meeting of the Society for Medical Decision Making; 10/2009