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 advanced cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT) 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 modelwas 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.

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

“…IMPT, intensity-modulated proton radiation therapy; IMRT, intensity-modulated photon-radiation therapy; NTCP, normal tissue complication probability; EV, expected value; QALY, quality-adjusted life-year; $, US dollars The Markov model design is a key step of CEA modeling for PBT. In our previous CEA modeling for paranasal sinus and nasal cavity cancer, a reliable 3-state Markov model was designed to simulate the tumor development and evaluate the cost-effectiveness of IMPT in comparison to IMRT in terms of tumor control improvement [32]. Unlike paranasal sinus and nasal cavity cancer, the advantages of IMPT over IMRT for OPC patients was the reduction of late toxicities whilst no improvement in tumor control or survival rates [33,34].…”

An Increasing Population of Patients With Oropharyngeal Carcinoma in China is Predicted to Benefit From Proton Beam Therapy in Terms of Cost-effectiveness Consideration 

“…In our previous CEA modelling for paranasal sinus and nasal cavity cancer, a reliable 3-state Markov model was designed to simulate the tumor development and evaluate the cost-effectiveness of IMPT in comparison to IMRT in terms of tumor control improvement [33]. Unlike paranasal sinus and nasal cavity cancer, the advantages of IMPT over IMRT for OPC patients lied in reducing late toxicities while not in improving tumor control or survival rates [34,35]. In this CEA modelling for OPC, we also used 3 main states including "alive with cancer", "no cancer" and "death" to simulate the tumor development of OPC, but the survival probabilities were set identical between IMPT strategy and IMRT strategy.…”