Optimizing oropharyngeal cancer management by using proton beam therapy: trends of cost-effectiveness.

Abstract

BACKGROUND:

Proton beam therapy (PBT) is a new-emerging cancer treatment in China but its treatment costs are high and not yet covered by Chinese public medical insurance. The advanced form of PBT, intensity-modulated proton radiation therapy (IMPT), has been confirmed to reduce normal tissue complication probability (NTCP) as compared to conventional intensity-modulated photon-radiation therapy (IMRT) in patients with oropharyngeal cancer (OPC). Herein, we evaluated the cost-effectiveness and applicability of IMPT versus IMRT for OPC patients in China, aiming at guiding the proper use of PBT.

METHODS:

A 7-state Markov model was designed for analysis. Base-case evaluation was performed on a 56-year-old (median age of OPC in China) patient under the assumption that IMPT could provide a 25% NTCP-reduction in long-term symptomatic dysphagia and xerostomia. Model robustness was examined using probabilistic sensitivity analysis, cohort analysis, and tornado diagram. One-way sensitivity analyses were conducted to identify the cost-effective scenarios. IMPT was considered as cost-effective if the incremental cost-effectiveness ratio (ICER) was below the societal willingness-to-pay (WTP) threshold.

RESULTS:

Compared with IMRT, IMPT provided an extra 0.205 quality-adjusted life-year (QALY) at an additional cost of 34,926.6 US dollars ($), and had an ICER of $170,082.4/ QALY for the base case. At the current WTP of China ($33,558 / QALY) and a current IMPT treatment costs of $50,000, IMPT should provide a minimum NTCP-reduction of 47.5, 50.8, 55.6, 63.3 and 77.2% to be considered cost-effective for patient age levels of 10, 20, 30, 40 and 50-year-old, respectively. For patients at the median age level, reducing the current IMPT costs ($50,000) to a $30,000 level would make the minimum NTCP-reduction threshold for "cost-effective" decrease from 91.4 to 44.6%, at the current WTP of China (from 69.0 to 33.5%, at a WTP of $50,000 / QALY; and from 39.7 to 19.1%, at a WTP of $100,000 / QALY).

CONCLUSIONS:

Cost-effective scenarios of PBT exist in Chinese OPC patients at the current WTP of China. Considering a potential upcoming increase in PBT use in China, such cost-effective scenarios may further expand if a decrease of proton treatment costs occurs or an increase of WTP level.

• Authors: Guo Li, Yun-Fei Xia, Yi-Xiang Huang, Deniz Okat, Bo Qiu, Jerome Doyen, Pierre-Yves Bondiau, Karen Benezery, Jin Gao, Chao-Nan Qian
• Journal: BMC cancer (BMC Cancer) Vol. 21 Issue 1 Pg. 944 (Aug 21 2021) ISSN: 1471-2407 [Electronic] England
• PMID: 34419008 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2021. The Author(s).

Topics

• Cost-Benefit Analysis
• Disease Management
• Health Care Costs (trends)
• Humans
• Male
• Markov Chains
• Middle Aged
• Oropharyngeal Neoplasms (economics, radiotherapy)
• Prognosis
• Proton Therapy (economics, methods, standards)
• Quality-Adjusted Life Years