Cost-effectiveness of particle therapy
Every published economic evaluation of proton, carbon-ion and BNCT therapy, with what each study compared, what it found, and how well it was reported.
How to read this table
An economic evaluation asks whether the extra health a treatment buys is worth its extra cost. The usual answer is an ICER: the additional cost divided by the additional quality-adjusted life year (QALY), a year of life weighted by how good that year is. A payer then compares the ICER with the most it is willing to pay for a QALY — its willingness-to-pay threshold. Below the threshold, the treatment is usually called cost-effective.
That makes every ICER local. It is a ratio in one currency, of one price year, judged against one country's threshold, under that study's own assumptions about what a course of treatment costs. So this table groups studies by currency and never converts between them, and it offers no single sorted league table of ICERs: sorting works inside a currency block, where the comparison means something. Price year is a column of its own, and it says not stated on the many studies that never reported one.
Each row links to a page for that study with a plain-language summary, the numbers it reported, and its reporting-quality score. The glossary explains every term in one place.
What the evidence says, in one glance
- Cost-effective10
- Not cost-effective4
- Cost-effective under conditions22
By modality
- Proton32
- Carbon ion4
“Cost-effective under conditions” is the commonest answer in this field: it means the study found particle therapy worth its cost for some patients, doses or fee levels and not others. Each study page names the condition.
Where the evidence is
Thirty years of economic evaluation has concentrated on a handful of indications — the ones where sparing healthy tissue has an obvious long-term pay-off — and has mostly concluded “it depends”.
- Cost-effective
- Cost-effective under conditions
- Not cost-effective
What a QALY was found to cost
One panel per currency, because that is the only unit inside which these figures can be compared. There is deliberately no chart putting dollars, euro and yen on one axis.
Each study's lowest reported cost per QALY, so a study with six scenarios cannot crowd the axis. The axis is logarithmic because the figures span three orders of magnitude. Thresholds differ by study and are in the hover text, not drawn as a line.
Not plotted — no cost-per-QALY figure reported: Sampaio et al 2024, Mailhot Vega et al 2016, Mailhot Vega et al 2015, Moriarty et al 2015, Parthan et al 2012.
Each study's lowest reported cost per QALY, so a study with six scenarios cannot crowd the axis. The axis is logarithmic because the figures span three orders of magnitude. Thresholds differ by study and are in the hover text, not drawn as a line.
Not plotted — reported dominance (cheaper and more effective, so no ratio): Lundkvist et al 2005.
Not plotted — no cost-per-QALY figure reported: Jensen et al 2019, Grutters et al 2011.
Each study's lowest reported cost per QALY, so a study with six scenarios cannot crowd the axis. The axis is logarithmic because the figures span three orders of magnitude. Thresholds differ by study and are in the hover text, not drawn as a line.
Not plotted — reported dominance (cheaper and more effective, so no ratio): Okazaki et al 2024.
Not plotted — no cost-per-QALY figure reported: Okazaki et al 2022, Yoshimura et al 2021, Mobaraki et al 2010.
Each study's lowest reported cost per QALY, so a study with six scenarios cannot crowd the axis. The axis is logarithmic because the figures span three orders of magnitude. Thresholds differ by study and are in the hover text, not drawn as a line.
How well it is reported
QHES scores for the studies in the table. For reference, the sixteen studies scored by hand in the owner's 2022 systematic review ran from 64 to 92.
The studies
36 of 36 studies
US dollars (US$)
17 studies · figures are comparable within this block only| Study | Modality | Indication | Comparator | Country | Cost per QALY as reported | Price year | Finding | Quality |
|---|---|---|---|---|---|---|---|---|
| Nantavithya et al 2025 International journal of particle therapy | Proton | Medulloblastoma | Photon beam therapy (XRT) | Thailand | -12 211 USD (-415 160 THB) per QALY · Base case, PBT vs XRT | not stated | Cost-effective under conditions | 88 |
| Viani et al 2025 Dialogues in health | Proton | Pediatric medulloblastoma (craniospinal irradiation 36 Gy with 54 Gy posterior fossa boost) | Photon therapy (photon radiotherapy for medulloblastoma) | Brazil | -US$10,904 per QALY · Proton vs photon (dominant) | 2025 | Cost-effective | 49 |
| Sampaio et al 2024 Cost effectiveness and resource allocation : C/E | Proton | Brain tumors (adult patients; specific histologies not specified in abstract) | Conventional radiotherapy (CRT) | Sweden | no ratio reported | 2021 Swedish Krona (SEK) | Not cost-effective | 78 |
| Li et al 2022 Prostate | Proton | Localized prostate cancer | Photon-based stereotactic body radiation therapy (SBRT) | China | US$47,456 per QALY · Base case (66-year-old, proton SBRT vs photon SBRT) | not stated | Cost-effective under conditions | 73 |
| Li et al 2022 Frontiers in medicine | Proton | Breast cancer (breast irradiation; cardiotoxicity / ischemic heart disease risk) | Photon (conventional photon) breast irradiation | China | $879,729.9 per QALY · baseline, protons vs photons | not stated | Cost-effective under conditions | 84 |
| Mailhot Vega et al 2021 Int J Radiat Oncol Biol Phys | Proton | Mediastinal Hodgkin lymphoma | Photon intensity modulated radiation therapy (IMRT) | United States | $129,000 per QALY · Base case, male patient (30-year-old) | not stated | Cost-effective under conditions | 80 |
| Li et al 2021 Head Neck | Proton | Nasopharyngeal carcinoma (T2N2M0) | IMRT (intensity-modulated photon radiation therapy) | China | US$102,684 per QALY · 10% NTCP reduction (median age 43) | not stated | Cost-effective under conditions | 92 |
| Brodin et al 2021 Radiat Oncol | Proton | Oropharyngeal carcinoma | IMRT (conventional photon therapy) | United States | $361,405 per QALY (median) · all patients | not stated | Cost-effective under conditions | 92 |
| Li et al 2021 BMC cancer | Proton | oropharyngeal cancer (OPC) | intensity-modulated photon-radiation therapy (IMRT) | China | US$170,082.4 per QALY · IMPT vs IMRT, base case (56-year-old) | not stated | Cost-effective under conditions | 74 |
| Li et al 2020 BMC Cancer | Proton | Paranasal sinus and nasal cavity cancers | Intensity-modulated photon radiation therapy (IMRT) | China | US$23,611 per QALY · Base case: IMPT vs IMRT, 47-year-old patient | not stated | Cost-effective under conditions | 79 |
| Xie et al 2020 Cost Eff Resour Alloc | Proton | Breast cancer (post-mastectomy, Stage III) | Standard of care (SOC); also IMRT, VMAT, Tomotherapy, mixed beam | United States | US$ 32,617 per QALY · VMAT vs SOC | not stated | Cost-effective under conditions | 77 |
| Sher et al 2018 Int J Radiat Oncol Biol Phys | Proton | Stage III-IVB oropharyngeal squamous cell carcinoma (HPV-positive and HPV-negative) | IMRT (intensity modulated radiation therapy) | United States | US$288,000 per QALY · HPV-positive OPC, payer perspective | not stated | Not cost-effective | 80 |
| Mailhot Vega et al 2016 Int J Radiat Oncol Biol Phys | Proton | Breast cancer | Conventional photon therapy | United States | no ratio reported | not stated | Cost-effective under conditions | 92 |
| Mailhot Vega et al 2015 Cancer | Proton | Central nervous system tumors (pediatric brain tumors; risk of growth hormone deficiency from hypothalamic dose) | Photon therapy (conventional radiation therapy / IMRT) | United States | no ratio reported | 2012 US$ | Cost-effective under conditions | 83 |
| Moriarty et al 2015 PloS one | Proton | Intraocular melanoma | Enucleation (reference); plaque brachytherapy | United States | $77,500 per quality-adjusted life-year · Plaque brachytherapy vs enucleation (base case) | 2011 | Cost-effective under conditions | 77 |
| Hirano et al 2014 J Radiat Res | Proton | Medulloblastoma (pediatric) | Conventional X-ray radiotherapy | Japan | $21,716 per QALY · EQ-5D | not stated | Cost-effective | 92 |
| Parthan et al 2012 Frontiers in oncology | Proton | localized prostate cancer | intensity-modulated radiation therapy (IMRT); stereotactic body radiation therapy (SBRT) is the index strategy | United States | no ratio reported | 2011 US dollars | Cost-effective under conditions | 92 |
euro (€)
7 studies · figures are comparable within this block only| Study | Modality | Indication | Comparator | Country | Cost per QALY as reported | Price year | Finding | Quality |
|---|---|---|---|---|---|---|---|---|
| Busschaert et al 2026 JAMA network open | Proton | Breast cancer (left- and right-sided; with and without regional nodal irradiation) | Photon radiotherapy delivered via deep inspiration breath-hold (DIBH) or free breathing (FB) | Belgium | €292 438 (95% CI €290 598-294 299) per QALY · Proton vs photon free breathing; moderate-to-high baseline CV risk, left-sided irradiation with regional nodal irradiation | 2024 (all cost data conv | Cost-effective under conditions | 92 |
| Jensen et al 2019 Radiation oncology (London, England) | Carbon ion | Adenoid cystic carcinoma (ACC) of the head and neck | IMRT only | Germany | 26,863 €/LY per life-year (LY) · Base case: IMRT+C12 boost vs IMRT only | 2015 (costs in € at 2015 | Cost-effective under conditions | 86 |
| Ramaekers et al 2012 Int J Radiat Oncol Biol Phys | Proton | Head and neck cancer | Photon IMRT (conventional radiation therapy) for all patients | Netherlands | EUR 60,278 per QALY gained · IMPT if efficient vs IMRT for all (base case) | not stated | Cost-effective under conditions | 85 |
| Grutters et al 2011 The oncologist | Proton | inoperable stage I non-small cell lung cancer | stereotactic body radiotherapy | Netherlands | no ratio reported | not stated | Cost-effective under conditions | 74 |
| Lundkvist et al 2005 Acta oncologica (Stockholm, Sweden) | Proton | left-sided breast cancer; prostate cancer; head and neck cancer; childhood medulloblastoma | Conventional radiation therapy | Sweden | €10,130 per QALY gained · average over the four cancers | 2002 (€1 = 9.2 SEK; cost | Cost-effective under conditions | 82 |
| Lundkvist et al 2005 Cancer | Proton | Medulloblastoma (childhood) | Conventional radiation therapy | Sweden | cost saving dominant (€23,600 cost saving and +0.68 QALY per patient) · base case, 5-year-old children with medulloblastoma | Euro 2002 value | Cost-effective under conditions | 89 |
| Lundkvist et al 2005 Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology | Proton | Breast cancer (left-sided) | Conventional radiation therapy | Sweden | 67,000 Euro per QALY gained · Base case, average breast cancer patient | EUR 2002 values (1 EUR = | Cost-effective under conditions | 92 |
Japanese yen (¥)
7 studies · figures are comparable within this block only| Study | Modality | Indication | Comparator | Country | Cost per QALY as reported | Price year | Finding | Quality |
|---|---|---|---|---|---|---|---|---|
| Yoshimura et al 2025 Journal of radiation research | Proton | Pediatric medulloblastoma | Conventional photon therapy | Japan | JPY 887053 per QALY · PBT vs photon therapy (base case) | not stated | Cost-effective | 80 |
| Okazaki et al 2024 Advances in radiation oncology | Carbon ion | Hepatocellular carcinoma (localized HCC ineligible for surgery or radiofrequency ablation) | Transarterial chemoembolization (TACE) | Japan | dominant (CIRT over TACE; higher LY and lower total cost, no ICER calculated) not applicable · primary analysis | not stated | Cost-effective | 83 |
| Sawada et al 2024 PloS one | Proton | locally advanced esophageal cancer (LAEC) | three-dimensional conformal radiotherapy (3D-CRT) | Japan | 14,025,268 yen (US$121,958) per QALY · higher PBT fee level (2,375,000 yen) | not stated | Cost-effective under conditions | 84 |
| Hiroshima et al 2023 Cancer medicine | Proton | Unresectable locally advanced pancreatic cancer (LAPC) | Three-dimensional conformal radiotherapy (3DCRT), a conventional photon RT | Japan | ¥5,376,915 (US$46,756) per QALY · PBT vs 3DCRT (base case) | not stated | Cost-effective | 78 |
| Okazaki et al 2022 Cancer science | Carbon ion | Clinical stage I non-small-cell lung cancer (NSCLC) | Stereotactic body radiotherapy (SBRT) | Japan | 7,491,017 JPY/LY per life year (LY) · All patients | not stated | Cost-effective | 71 |
| Yoshimura et al 2021 J Radiat Res | Proton | Medulloblastoma (pediatric) | Conventional X-ray (photon) therapy | Japan | JPY 3,856,398 per lifetime attributable risk (LAR) of secondary cancer | not stated | Cost-effective | 67 |
| Mobaraki et al 2010 Cancer science | Carbon ion | Locally recurrent rectal cancer | Conventional multimodality therapy (three-dimensional conformal radiotherapy, chemotherapy, and hyperthermia) | Japan | yen6428 per 1% increase in survival · CIRT vs multimodality therapy | not stated | Cost-effective | 57 |
Australian dollars (A$)
2 studies · figures are comparable within this block only| Study | Modality | Indication | Comparator | Country | Cost per QALY as reported | Price year | Finding | Quality |
|---|---|---|---|---|---|---|---|---|
| Austin et al 2020 J Med Radiat Sci | Proton | Left-sided breast cancer | Intensity-modulated photon therapy (IMRT/X-ray) with deep inspiration breath-hold (DIBH) | Australia | AU$84,600 per QALY · Average ICER across the 16-patient cohort | not stated | Cost-effective under conditions | 64 |
| Austin et al 2019 Australas Phys Eng Sci Med | Proton | Base of skull chordoma | Conventional photon radiotherapy (VMAT per abstract) | Australia | below 20,170 per QALY (currency as AU$; written without symbol in appendix) · all 7 patients, proton vs conventional radiation therapy | not stated | Cost-effective | 73 |
pounds sterling (£)
1 study · figures are comparable within this block only| Study | Modality | Indication | Comparator | Country | Cost per QALY as reported | Price year | Finding | Quality |
|---|---|---|---|---|---|---|---|---|
| Jones et al 2023 Clinical oncology (Royal College of Radiologists (Great Britain)) | Proton | Intermediate-stage Hodgkin lymphoma (ISHL) | Volumetric modulated arc therapy (VMAT), both in deep-inspiration breath-hold | UK | no ratio reported | 2014/15 | Not cost-effective | 65 |
New Taiwan dollars (NT$)
1 study · figures are comparable within this block only| Study | Modality | Indication | Comparator | Country | Cost per QALY as reported | Price year | Finding | Quality |
|---|---|---|---|---|---|---|---|---|
| Leung et al 2016 Oncotarget | Proton | Hepatocellular carcinoma (inoperable advanced / large) | Stereotactic body radiation therapy (SBRT) | Taiwan | NT$ 213,354 per QALY gained · Proton beam therapy vs SBRT, base case | not stated | Cost-effective | 76 |
$ (currency not specified beyond the symbol)
1 study · figures are comparable within this block only| Study | Modality | Indication | Comparator | Country | Cost per QALY as reported | Price year | Finding | Quality |
|---|---|---|---|---|---|---|---|---|
| Fernandes et al 2019 Value Health Reg Issues | Proton | Pediatric medulloblastoma | Conventional photon radiation therapy | Brazil | $34,390 per QALY · Base case: 50 patients/year, 20-year equipment life span | not stated | Not cost-effective | 70 |