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. Costeffective 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, costeffective 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.

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

“…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 ]…”

“…The Sher et al [ 28 ] constructed their model based off the history of a 65-year-old patient with HNC, on top of which various sensitivity models were applied. Three CEMs, except for Lundkvist et al [ 26 ] provided justification for model structure, although the Ramaekers et al [ 27 ] model provided no reference, and the Li et al [ 20 ] model was based only on an older published study. All 4 CEMs directed appropriate attention toward significant parameters; however, exact methods of data identification, selection, and quality assessment were unreported.…”

“…Survival rates were estimated from the Swedish cancer registry, with the relative mortality risk of PBT based purely off assumptions. The Li et al [ 20 ] study, from 2020, assumed differential probabilities eradicating disease in the setting of paranasal sinus and nasal cavity cancers [ 30 ]. In contrast, both the Ramaekers et al [ 27 ] and Sher et al [ 28 ] studies (in 2013 and 2018, respectively) generally considered PBT and IMRT to be analogous with respect to disease and/or survival outcomes (although the Ramaekers et al [ 27 ] study also explored the alternative scenario in the sensitivity analysis).…”

“…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 – 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 – 20 ].…”