Brief courses of palliative radiotherapy for metastatic bone pain - A pilot cost-minimization comparison with narcotic analgesics

The use of radiotherapy to treat metastatic bone pain is being challenged b y claims of high cost and by more readily available, noninvasive treatment approaches. The authors assessed the effectiveness of brief courses of radi otherapy in reducing pain and estimated cost data for a pilot comparison be tween radiotherapy and narcotic analgesics in patients with cancer. A repre sentative group of outpatients undergoing brief courses of radiotherapy wit h Karnofsky scores above 70 and without serious comorbidities were recruite d from 1995 through 1996. Patients indicated their pain at rest and with mo vement on a scale of from 1 to 10 both before and up to 12 months after rad iotherapy. Radiotherapy costs were estimated from Medicare-allowable charge s. Narcotic analgesia costs were estimated from published values. In 66 pat ients with 131 individually treated sites, median at rest pain score decrea sed by about 4 points after treatment (5.58 [+/-3.28] before treatment vs. 1.55 [+/-1.8] after treatment; p < 0.05). Median with movement pain score w as about 5 points lower after treatment (7.32 [+/-2.72] before treatment vs . 1.94 [+/-2.07] after treatment; p < 0.05). No differences were found when stratifying by type of pain, tumor histologic type, or skeletal site. The estimated cost per patient ranged from $1,200 to $2,500 for radiotherapy. T his compares with an estimated cost of $9,000 to $36,000 for 9 months of na rcotics. In this pilot study, a brief course of radiotherapy significantly reduced pain and appeared to be cost effective when compared with narcotic analgesia. A full economic evaluation is warranted.