Cost-effectiveness analysis of cochlear dose reduction by proton beam therapy for medulloblastoma in childhood

• Published in: Journal of radiation research Vol. 55; no. 2; pp. 320 - 327
• Main Authors: Hirano, Emi, Fuji, Hiroshi, Onoe, Tsuyoshi, Kumar, Vinay, Shirato, Hiroki, Kawabuchi, Koichi
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2014
• Subjects: Analysis; Cerebellar Neoplasms - economics; Cerebellar Neoplasms - mortality; Cerebellar Neoplasms - radiotherapy; Child; Cochlea - radiation effects; Cost benefit analysis; Cost engineering; Cost-Benefit Analysis - classification; Cost-Benefit Analysis - economics; Costs; Economic aspects; Female; Health aspects; Health care costs; Health Care Costs - statistics & numerical data; Hearing Loss - economics; Hearing Loss - mortality; Hearing Loss - prevention & control; Humans; Japan; Male; Markov processes; Mathematical models; Medulloblastoma; Medulloblastoma - economics; Medulloblastoma - mortality; Medulloblastoma - radiotherapy; Models, Economic; Oncology; Organ Sparing Treatments - economics; Organ Sparing Treatments - methods; Organs at Risk - radiation effects; Proton beams; Protons - therapeutic use; Quality of Life; Radiation Injuries - economics; Radiation Injuries - prevention & control; Radiation Protection - economics; Radiotherapy; Radiotherapy Dosage; Radiotherapy, High-Energy - economics; Radiotherapy, High-Energy - mortality; Reduction; Retrospective Studies; Survival Rate; Therapy; Treatment Outcome; X-rays; Japan; proton therapy; hearing loss; medulloblastoma; cost effectiveness
• ISSN: 0449-3060; 1349-9157
• DOI: 10.1093/jrr/rrt112

Background: The aim of this study is to evaluate the cost-effectiveness of proton beam therapy with cochlear dose reduction compared with conventional X-ray radiotherapy for medulloblastoma in childhood. Methods: We developed a Markov model to describe health states of 6-year-old children with medulloblastoma after treatment with proton or X-ray radiotherapy. The risks of hearing loss were calculated on cochlear dose for each treatment. Three types of health-related quality of life (HRQOL) of EQ-5D, HUI3 and SF-6D were used for estimation of quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for proton beam therapy compared with X-ray radiotherapy was calculated for each HRQOL. Sensitivity analyses were performed to model uncertainty in these parameters. Results: The ICER for EQ-5D, HUI3 and SF-6D were $21 716/QALY, $11 773/QALY, and $20 150/QALY, respectively. One-way sensitivity analyses found that the results were sensitive to discount rate, the risk of hearing loss after proton therapy, and costs of proton irradiation. Cost-effectiveness acceptability curve analysis revealed a 99% probability of proton therapy being cost effective at a societal willingness-to-pay value. Conclusions: Proton beam therapy with cochlear dose reduction improves health outcomes at a cost that is within the acceptable cost-effectiveness range from the payer's standpoint.