Abstract
BackgroundParticle therapy provides steep dose gradients to facilitate dose escalation in challenging anatomical sites which has been shown not only to improve local control but also overall survival in patients with ACC. Cost-effectiveness of intensity-modulated radiotherapy (IMRT) plus carbon ion (C12) boost vs IMRT alone was performed in order to objectivise and substantiate more widespread use of this technology in ACC.MethodsPatients with pathologically confirmed ACC received a combination regimen of IMRT plus C12 boost. Patients presenting outside C12 treatment slots received IMRT only. Clinical results were published; economic analysis on patient-level data was carried out from a healthcare purchaser’s perspective based on costs of healthcare utilization. Cost histories were generated from resource use recorded in individual patient charts and adjusted for censoring using the Lin I method. Cost-effectiveness was measured as incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed regarding potentially differing management of recurrent disease.ResultsThe experimental treatment increased overall costs by € 18,076 (€13,416 – €22,922) at a mean survival benefit of 0.86 years. Despite improved local control, following costs were also increased in the experimental treatment. The ICER was estimated to 26,863 €/LY. After accounting for different management of recurrent disease in the two cohorts, the ICER was calculated to 20,638 €/LY.ConclusionThe combined treatment (IMRT+C12 boost) substantially increased initial and overall treatment cost. In view of limited treatment options in ACC, costs may be acceptable though. Investigations into quality of life measures may support further decisions in the future.
Highlights
Particle therapy provides steep dose gradients to facilitate dose escalation in challenging anatomical sites which has been shown to improve local control and overall survival in patients with adenoid cystic carcinoma (ACC)
We present our economic evaluation of intensity-modulated radiotherapy (IMRT) plus Carbon ion (C12) boost in ACC of the head and neck using patient-level data of the two patient cohorts recently published [13]
Within the German C12 pilot project between 1997 and 2008, C12 was clinically available in three treatment periods (20 days) per year; outside these periods, patients were treated with standard IMRT by the same team of physicians
Summary
Particle therapy provides steep dose gradients to facilitate dose escalation in challenging anatomical sites which has been shown to improve local control and overall survival in patients with ACC. Due to limited availability of particle therapy and rarity of the disease [13, 14], no randomized trials have been performed to compare standard photon and carbon ion therapy. Despite approval of this treatment for ACCs in Germany following publication of initial favourable results in 2004, it is still a matter of considerable debate in the international radiotherapy community whether particle therapy is cost-effective.
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