Abstract
BackgroundCost-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.MethodsA 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)).ResultsIMPT 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.ConclusionsDespite 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.
Highlights
Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries
Due to deficiency of valid data and lacking of a uniform model pattern, effective and reliable cost-effectiveness analysis (CEA) studies of proton beam therapy (PBT) are rare worldwide [22]. Some classical studies such as a 3-state Markov model designed for breast cancer, which focused on the advantages of intensity modulated proton radiation therapy (IMPT) in reducing the incidence of irradiation-induced coronary heart disease, concluded that IMPT was cost-effective for patients with 1 cardiac risk factors when photon are unable to achieve mean dose of heart < 5 Gy [23]. Another 6state Markov model designed for Stage IVa oropharynx cancer, which was based on a hypothesis that IMPT could make a 25% reduction of xerostomia, dysgeusia and the need for gastrostomy tube, concluded that IMPT was cost-effective only in younger patients who could benefit from profound reductions of long-term morbidity [24]
To the best of our knowledge, this is the first CEA study of PBT designed for the specific situation of China
Summary
Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries. 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. According to an authoritative systematical review, compared to IMRT, PBT has been found to improve the 5-year overall survival rate of paranasal sinus and nasal cavity cancer from 45.1 to 69.7% [7]. For this reason, paranasal sinus and nasal cavity cancers were included as the “Group 1′′ indication of PBT in the “Proton Beam Therapy Model Policy” by the American Society for Radiation Oncology [8]
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