Cost‐effectiveness of proton radiation in the treatment of childhood medulloblastoma

Abstract

BACKGROUND Radiation therapy is an important component in the treatment of medulloblastoma; however, in many patients, it is associated with risk of late adverse events. Proton radiation therapy has potential to reduce the risk of adverse events compared with conventional radiation, but it is associated with a higher treatment cost. The objective of the current study was to assess the cost‐effectiveness of proton therapy compared with conventional radiation therapy in the treatment of childhood medulloblastoma. METHODS The consequences of radiation therapy were evaluated using a Markov simulation model. Children age 5 years with medulloblastoma were followed. The patients were at risk of several types of adverse events, including hearing loss, intelligence quotient (IQ) loss, hypothyroidism, growth hormone deficiency (GHD), osteoporosis, cardiac disease, and secondary malignancies. The patients also were at risk of death and were divided into risk groups for normal death, death due to tumor recurrence, treatment‐related cardiac death, treatment‐related subsequent tumor death, or treatment‐related other death. A review of the literature was conducted to estimate the parameters in the model. RESULTS The base‐case results showed that proton therapy was associated with €23,600 in cost savings and 0.68 additional quality‐adjusted life‐years per patient. The analyses showed that reductions in IQ loss and GHD contributed to the greatest part of the cost savings and were the most important parameters for cost‐effectiveness. CONCLUSIONS The results of the current study indicated that proton radiation therapy can be cost‐effective and cost‐saving compared with conventional radiation therapy in the treatment of children with medulloblastoma if the appropriate patients are selected for the therapy. However, there have been few long‐term follow‐up studies, and more much information on the long‐term consequences of radiation therapy is needed. Cancer 2005. © 2005 American Cancer Society.

Proton beam therapy

“…Current estimates place the relative cost of proton radiation therapy compared to IM photon beam radiation therapy in the range of 2.4, but might come down to 1.7 -2.1 over the next 5 years (Goitein and Jermann, 2003). A recent publication from Sweden actually projected lower health-care expenses using proton beam radiotherapy when compared to conventional radiation therapy in the treatment of a child with medulloblastoma, because of the substantial health-care burden in managing the late effects of conventional radiotherapy (Lundkvist et al, 2005).…”

Current status of radiotherapy with proton and light ion beams

“…In a recent cost analysis of proton therapy in childhood medulloblastoma, proton-beam irradiation was considered to be more cost-effective than conventional photon irradiation. 98 The reduction in overall costs predicted in that study derives from the controversial claim that proton beam therapy will be associated with a reduced the risk of growth hormone deficiency and decreased intelligence quotient.…”

Randomized controlled trials in health technology assessment: Overkill or overdue?

“…However, the detailed assumptions of a cost-effectiveness estimation -in the absence of precise differential cost-effectiveness data from a randomized phase III trial with individual patientlevel cost data -will critically affect the conclusions and a number of similar exercises have come out favorably for proton therapy [44][45][46]. Some debaters have argued that as long as there is an under-provision of (photon) radiation therapy in many countries [47], large investments in proton facilities should be put on hold.…”