Economic impact of stereotactic radiosurgery for malignant intracranial brain tumors

Brain metastases occur frequently in cancer patients and can lead to neurological complications that result in decreased quantity and quality of life. Treatment alternatives include whole-brain radiation therapy, neurosurgery and the newest modality, stereotactic radiosurgery (SRS). This article reviews economic evaluations of SRS in the metastatic setting compared with other treatment options. Studies were included if they were published in peer-reviewed journals, primarily focused on patients with malignant brain metastasis and included a cost analysis between interventions. Uncertainty surrounding the cost-effectiveness of SRS is due to a lack of efficacy information between treatment alternatives, methodological limitations and design differences between the available studies. When cost-effectiveness ratios are available, SRS appears to be a reasonable option in resource-limited settings, with incremental cost-effectiveness ratios just below the US$50,000 range. However, better-designed economic analysis in the setting of randomized clinical trials or observational studies needs to be conducted to fully understand the economic value of SRS.