Before starting, want to give a HUGE thanks to my first #radonc mentor James Murphy (not on Twitter) from @UCSDRadMed who taught me this type of research & to co-authors.

I look forward to doing this type of work @DukeRadOnc 2/n
Costs assoc w/ tx & disease progression depend on cancer type. We identified costs from the lit for pts w/ metastatic colorectal, lung, prostate, & breast cancer, & used a weighted avg to reflect SABR-COMET.

Cost of SABR was estimated using Medicare reimbursement rates. 4/n
1-way sensitivity analysis: model not sensitive to assumptions about SABR cost- it would need to https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> ≥10X (!!) from $12,500 to $145,688 (health care sector) or $127,150 (societal) before SABR became cost-ineffective. 6/n
SABR would be a cost-effective tx 99.8% (health care) or 98.7% (societal ) of the time at WTP of $100,000/QALY. https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">WTP to $50,000/QALY: SABR cost-effective 87.8% (health care) or 71.1% (societal). https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> $200,000/QALY: SABR cost effective >99.9% (health care) or 99.9% (societal) 8/n
We are not the 1st to show SABR cost-effectiveness. @DrLesterColl & @davidSher showed in a recent review of 24 studies involving SABR that it was the cost-effective option in 80% of studies. https://link.springer.com/article/10.1007%2Fs11912-017-0599-0

In">https://link.springer.com/article/1... our analysis SABR cost represented <5% total costs (!) 9/n
@VPrasadMDMPH writes, “Before you conduct a cost-effectiveness analysis, you have to know that a therapy is effective”. Many Ph2 trials in oligometastatic dz in addition to SABR-COMET indicate benefit of SABR. Ph3 trials needed to clarify which pts will benefit most. 10/n
Yet, in this era of cost-savings/reduced/bundled payments, I believe this research is important *now* to show **value** of radiation treatment.

Thanks all for making it this far in my 1st tweetorial https://abs.twimg.com/emoji/v2/... draggable="false" alt="đź§µ" title="Thread" aria-label="Emoji: Thread">.

Final/n
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