Stereotactic Ablative Body Radiotherapy (SABR) versus Radiofrequency Ablation and cryoablation for Primary Renal Cell Carcinoma: an economic evaluation of the FASTRACK II trial

Constanza Vargas; Joe Carrello; Mathias Bressel; Mark Sidhom; Charles Lin; Ben Vanneste; Daniel Moon; Sree Appu; Anand Swaminath; Jeremy Ruben; David Pryor; Braden Higgs; Ryan Davey; Nicholas Hardcastle; Rebecca Montgomery; Shankar Siva; Richard De Abreu Lourenço

doi:10.1016/j.ijrobp.2025.05.089

Stereotactic Ablative Body Radiotherapy (SABR) versus Radiofrequency Ablation and cryoablation for Primary Renal Cell Carcinoma: an economic evaluation of the FASTRACK II trial

Int J Radiat Oncol Biol Phys. 2025 Jun 25:S0360-3016(25)03910-0. doi: 10.1016/j.ijrobp.2025.05.089. Online ahead of print.

Authors

Constanza Vargas¹, Joe Carrello², Mathias Bressel³, Mark Sidhom⁴, Charles Lin⁵, Ben Vanneste⁶, Daniel Moon⁷, Sree Appu⁸, Anand Swaminath⁹, Jeremy Ruben¹⁰, David Pryor¹¹, Braden Higgs¹², Ryan Davey¹³, Nicholas Hardcastle¹⁴, Rebecca Montgomery¹³, Shankar Siva¹⁴, Richard De Abreu Lourenço²

Affiliations

¹ Centre for Health Economics and Evaluation, University of Technology Sydney, Sydney, NSW, Australia. Electronic address: Constanza.vargas@uts.edu.au.
² Centre for Health Economics and Evaluation, University of Technology Sydney, Sydney, NSW, Australia.
³ Center for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Radiation Oncology, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
⁴ Department of Radiation Oncology, Liverpool Hospital, Sydney, NSW, Australia.
⁵ Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
⁶ Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Human Structure and Repair, Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium.
⁷ University of Melbourne, Royal Melbourne Clinical School, Melbourne, VIC, Australia.
⁸ Cabrini Dept of Surgery, Monash University, Melbourne, Australia.
⁹ Department of Oncology, Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
¹⁰ Alfred Health Radiation Oncology, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia.
¹¹ Department of Urology and Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia.
¹² Department of Radiation Oncology, Royal Adelaide Hospital, South Australia, Australia; University of South Australia, Adelaide, SA, Australia.
¹³ TransTasman Radiation Oncology Group, Waratah, NSW, Australia.
¹⁴ Department of Radiation Oncology, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.

PMID: 40578451
DOI: 10.1016/j.ijrobp.2025.05.089

Abstract

Purpose: The Anonymized trial demonstrated the safety and efficacy of stereotactic ablative body radiotherapy (SABR) in patients with inoperable renal cell carcinoma (RCC). In this study, we investigated whether SABR was cost-effective compared to the thermal ablation strategies of radiofrequency ablation (RFA) and cryoablation (CA).

Methods: The cost-effectiveness analysis was conducted from an Australian public health care system perspective using data from Australian patients enrolled into the Anonymized trial and estimates from the literature for the comparators. Health-related quality of life (HRQoL) was measured using the EORTC-QLQC30 questionnaire and converted to utility values using the QLU-C10D instrument with Australian utility weights. HRQoL was analysed using a mixed model for repeated measures. SABR costs were obtained from linked administrative data records and were analysed using a generalized linear model. A 10-year time horizon was applied to a Markov model with health states of localized RCC, progression-free, local progression, metastasis, and death was developed. Outcomes were expressed as quality-adjusted life years (QALYs), with the intent to estimate an incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted.

Results: The mixed model for repeated measures (MMRM) showed that over the study duration there was a decrease in HRQoL after SABR compared to baseline. After an initial decline, mean scores approached baseline but remained lower, largely due to changes in fatigue and dyspnea. The economic evaluation showed SABR was more effective and less costly compared to RFA and CA. SABR remained dominant in all deterministic sensitivity analyses and the probabilistic sensitivity analysis showed that SABR had a higher cost compared to RFA in only 10% of iterations, remaining cost-effective.

Conclusions: Our findings show that while there is an initial reduction in HRQoL post-SABR, it is a more effective and less costly compared to RFA and CA in patients with inoperable RCC. From a cost-effectiveness perspective, it should be considered the treatment of choice in this population.