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

• Published in: BMC cancer Vol. 21; no. 1; pp. 944 - 11
• Main Authors: Li, Guo, Xia, Yun-Fei, Huang, Yi-Xiang, Okat, Deniz, Qiu, Bo, Doyen, Jerome, Bondiau, Pierre-Yves, Benezery, Karen, Gao, Jin, Qian, Chao-Nan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.08.2021; BioMed Central; BMC
• Subjects: Analysis; Cancer therapies; Care and treatment; Chemotherapy; Confidence intervals; Cost analysis; Cost benefit analysis; Cost-effectiveness analysis; Diagnosis; Disease Management; Dosimetry; Dysphagia; Economic aspects; Forecasts and trends; Health Care Costs - trends; Human papillomavirus; Humans; Intensity-modulated photon-radiation therapy; Intensity-modulated proton radiation therapy; Male; Markov Chains; Markov model; Medical care, Cost of; Middle Aged; Monte Carlo simulation; Oropharyngeal cancer; Oropharyngeal Neoplasms - economics; Oropharyngeal Neoplasms - radiotherapy; Ostomy; Patients; Prognosis; Proton beam radiotherapy; Proton beam therapy; Proton Therapy - economics; Proton Therapy - methods; Proton Therapy - standards; Quality-Adjusted Life Years; Radiation therapy; Sensitivity analysis; Sexual behavior; Software; Throat cancer; Xerostomia; China; United States > US; Cost-effectiveness analysis; Intensity-modulated photon-radiation therapy; China; Oropharyngeal cancer; Markov model; Intensity-modulated proton radiation therapy; Proton beam therapy
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-08638-2

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. 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. 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). 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.