Voort van Zyp NC 2010 2 years 97% 62% Vahdat S 2010 42 – 60 Gy in 3 f 20 Stage IA 43 months 2 year 95% 90% Brown WT 2009 60-67.5 Gy in 3-5 f 31 peripheral Stage I 27.5 (24- 53) 4.5 years 85.5% 83.5% Van der Voort van Zyp NC 2009 60 Gy in 3 f 70 peripheral stage T1 & T2 15 months 1 & 2 years 96% Ahn SH 2009 36-54 Gy in 3 f 8 Stage I 2 years 87.5% Collins BT 2009 42-60 in 3 f 20 Peripheral Stage I 25 months 2 100% 87% Coon D 2008 60 Gy in 3 f 26 stage I 12 months 1 year 85% 81% Collins BT 2007 45-60 Gy in 3 24 1 12 months 1 year 100% 87% Brown WT 2007 15 to 67.5 Gy in 1-5 f 59 1 to 33 months 85% Brown WT 2007 15 to 67.5 Gy in 1-5 f 95 1 to 36 months 82% Brown WT 2007 24 to 60 Gy in 3 f 19 Stage 1A 1-25 months 86% Nuyttens JJ 2006 30 to 60 Gy in 3 f 20 4 months 100% * Comparison with resection ** Comparison with 3D-CRT 3DCRT 14 papers were considered by the applicant as ‘usable’. This usability was determined by the reporting of outcomes, especially overall survival, making it possible to compare the outcomes in these papers with those in the papers reporting on CyberKnife. Table B3: Conformal Radiotherapy Relevant Papers Paper Dose Patients Follow-up - median Kaplan- Meier Local control Overall survival Price A 2012 55 Gy in 20 f 105 Stage T1-2 A w/o B w chemo 2 years 5 years A 56% B 52% A 20% B 33% Bradley JD 2010 74 Gy 53 Stage I-III 19.3 months (13.1- 57.9-72) 1 year 75.5% Wurstbauer K 2010 88.2 GY 69.3 Gy 56.7 Gy 30 I 8 Stage II 39 Stage IIIA 47 Stage IIIB 19 months 2 5 years I 57% 20% Stage II 75% 13% trial
2009 2.5 Gy per f 138.9) Belliere A 2009 74 Gy 50 Stage IIIA/B Campeau MP 2009 60 Gy in 30 f w chemo 60 Gy in 30 f w/o chemo 50-55 Gy in 20 f 73 Stage I 18 months (1-81) 2 year 57% w chemo 33% w/o chemo Sura S 2008 IMRT 55 Stage I-IIIB 26 months 2 year Stage I/II 50% Stage III 58% I/II 55% Stage III 58% Low JSh 2007 55 Gy 23 Stage I 18.9 months (6.2- 117.4) 2 year 3 year 54.7% 24.3% Sura S 2007 ≥ 80 Gy 55 I/II 27 Stage IIIA/B 5 year I/II 67% Stage IIIA/B 39% I/II 36% Stage IIIA/B 31% Faria SL 2006 52.5 Gy in 15 f hyper 32 Stage T1-2 2 year 56% Fang LC 2006 66 GY 85 Stage I 19 Months (3-77) 2 year 5 year 77% 70% 68% 36% Chen M 2006 63 to 102.9 Gy in 2.1 Gy f 106 Stage I-III recurrent 104 months 1 year 2 years 3 years 4 years 86% 61% 43% 21% Kong FM 2005 63 to 103 Gy in 2.1 Gy f 106 I-III recurrent 5 year 63-69 Gy 4% 74-84 Gy 22% 92-103 Gy 28% Rosenzweig KE 2001 70.2 Gy 32 early stage 2 year 5 year 54% 33% Systematic Reviews of CyberKnife None provided. Reported two year control ranged from 87.5% (n=8) to 100% (n=20) in the CyberKnife studies compared to 67% (n=55) to 77% (n=85) in the studies on 3DCRT. Two year survival ranged from 62% (n=39) to 90% (n=20) in the CyberKnife studies compared to 54.7% (n=23) to 61% (n=106) in the studies reporting on 3DCRT. Longer term data were available for patients in the 3DCRT studies (5 years) with one CyberKnife study reporting overall survival at 4.5 years.
Current funding for a standard course of 3DCRT for prostate cancer The course of treatment cost using 3DCRT was calculated using current MBS item numbers and the Radiation Oncology Health Program Grant (ROHPG) payments. Table C3a: Cost of current Course of Treatment using Dual Photon 3D-CRT MBS Item number Description MBS fee attendance* ROHPG payment per attendance Number of attendances Total 15550 15562 15705 Simulation Dosimetry Treatment Treatment Verification $646.30 $1,099.85 $58.55 $170.30 $76.60 $101.94 $107.44 $55.97 1 1 35 35 11 $748.24 $1,207.29 $4,008.20 $5,960.50 $842.60 Total $12,767 * As at May 2012 Proposed funding of a course of CyberKnife The costs are based on running a CyberKnife facility that has the capacity to build up to a throughput of 250 patients per year. Two different throughput scenarios were then modelled assuming a ten year life for the capital equipment (CyberKnife). It is important to note that it has been assumed that the predominant cancer treated with CyberKnife (assuming funding) will be prostate cancer. The following economic model determines the cost per fraction using CyberKnife based on this assumption. Table C6: Proposed fees for a standard course of treatment for prostate cancer with CyberKnife MBS Item number Description Claims per patient MBS fee attendance ROHPG per attendance Total cost per patient 15550 Simulation 1 $646.30 $101.94 $748.24 15562 Dosimetry 1 $1,099.85 $107.44 $1,207.29 15xxx Treatment 5 $472.05 $407.82 $4,399.34 15xxx Treatment 5 $1,200.68 n/a $6,003.41 15705 Verification 5 $76.60 n/a $383.00 Total $12,741 The cost per fraction in a course of therapy using CyberKnife for patients with early stage NSCLC unsuited for surgery appears to have been modelled as has been set out in the concurrent submission for prostate cancer.