Cost-effectiveness analysis of proton beam therapy for treatment decision making in paranasal sinus and nasal cavity cancers in China

Abstract

Background: Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT, the advanced form of proton beam therapy) has been found to improve the prognosis of the patients with paranasal sinus and nasal cavity cancers compared with intensity-modulated photon-radiation therapy (IMRT). However, the cost-effectiveness of IMPT has not yet been fully evaluated. This study aimed at evaluating the cost-effectiveness of IMPT versus IMRT for treatment decision making of paranasal sinus and nasal cavity cancers in Chinese settings.Methods: A 3-state Markov model was designed for cost-effectiveness analysis. A base case evaluation was performed on a patient of 47-year-old (median age of patients with paranasal sinus and nasal cavity cancers in China). Model robustness was examined by probabilistic sensitivity analysis, Markov cohort analysis and Tornado diagram. Cost-effective scenarios of IMPT were further identified by one-way sensitivity analyses and stratified analyses were performed for different age levels. The outcome measure of the model was the incremental cost-effectiveness ratio (ICER). A strategy was defined as cost-effective if the ICER was below the societal willingness-to-pay (WTP) threshold of China (30,828 US dollars ($) / quality-adjusted life year (QALY)).Results: IMPT was identified as being cost-effective for the base case at the WTP of China, providing an extra 1.65 QALYs at an additional cost of $38,928.7 compared with IMRT, and had an ICER of $23,611.2 / QALY. Of note, cost-effective scenarios of IMPT only existed in the following independent conditions: probability of IMPT eradicating cancer ≥ 0.867; probability of IMRT eradicating cancer ≤ 0.764; or cost of IMPT ≤ $52,163.9. Stratified analyses for different age levels demonstrated that IMPT was more cost-effective in younger patients than older patients, and was cost-effective only in patients ≤ 56-year-old.Conclusions: Despite initially regarded as bearing high treatment cost, IMPT could still be cost-effective for patients with paranasal sinus and nasal cavity cancers in China. The tumor control superiority of IMPT over IMRT and the patient’s age should be the principal considerations for clinical decision of prescribing this new irradiation technique.

Cost-Effectiveness Models of Proton Therapy for Head and Neck: Evaluating Quality and Methods to Date

“…Search terms were restricted from 2000 through 2020 and included the following headings: head-and-neck, oropharynx, thyroid, salivary, larynx, hypopharynx, oral cavity, nasal, orbit, nasopharynx, paranasal, protons, proton radiation, proton beam, cost, cost-effectiveness, value, and economics. Four full CEMs specific to HNC were identified [17][18][19][20], which (1) compared PBT to any comparators, and (2) expressed results in terms of cost per QALY gained. The bibliography of each CEM was reviewed, and subsequent citations were tracked in Scopus (Elsevier, Amsterdam, the Netherlands) to identify any newly published studies meeting inclusion criteria.…”

“…The bibliography of each CEM was reviewed, and subsequent citations were tracked in Scopus (Elsevier, Amsterdam, the Netherlands) to identify any newly published studies meeting inclusion criteria. General characteristics, modeling information, and methodological approaches were extracted for each identified study [17][18][19][20].…”

“…With significant limitations, the authors concluded that PBT, in general, was not cost effective from either the payer or societal perspectives (at a threshold of US $100 000 in 2016) and would only be cost effective from the payer perspective under favorable conditions for young HPV þ patients. Li et al [20] The Chinese Markov cohort model compared IMPT versus IMRT for treating paranasal sinus and nasal cavity cancers from a Chinese health care perspective. The model adopted a simple structure of only 3 health states: no cancer, alive with cancer (including recurrent, metastatic, or residual disease), and death.…”

“…The Sher et al [28] study lacked both criteria and failed to explore the actual generalizability of their findings (or lack thereof). The Li et al [20] study did not report mean estimated outcomes or costs for each radiation therapy and lacked recognition of and discussion of previous studies [26,27] Methodological Quality (Supplemental Material Table S2)…”

Proton beam therapy for children and adolescents and young adults (AYAs): JASTRO and JSPHO Guidelines

“…Therefore, long-term follow-up in clinical practice is necessary to assess the effect of PBT on decreasing onset of second cancer. SR-3: Cost-effectiveness of proton beam therapy [28][29][30][31][32][33][34][35][36][37][38][39][100][101][102][103][104][105][106] All of the above studies estimated the reduction in adverse events using organ doses calculated based on a radiotherapy plan and a model for the relationship between organ doses and effects. PBT for childhood brain tumor, particularly medulloblastoma, was confirmed to have better cost-effectiveness due to reduced adverse events.…”