Parthan et al 2012
Frontiers in oncology · 2012 · United States · Proton
This cost-utility analysis used a lifetime Markov model to compare several external beam radiation options for localised prostate cancer in a hypothetical cohort of 65-year-old men who had declined or were ineligible for surgery. Toxicity probabilities were derived from published sources using meta-analytical techniques, and utilities and costs came from publicly available secondary sources, with analyses run from both payer and societal perspectives in the United States. The study concluded that stereotactic body radiation therapy (SBRT) was less costly and gave more quality-adjusted life years than intensity-modulated radiation therapy (IMRT) and proton beam therapy (PT), on the assumption that all modalities give equivalent long-term efficacy.
What it compared
Proton beam therapy and IMRT as comparators to SBRT, the index strategy, in a hypothetical cohort of 65-year-old men with localised prostate cancer who declined or were ineligible for surgery.
What it found
At a threshold of US$50,000 per QALY, SBRT was cost-effective in 75% of probabilistic simulations versus IMRT and 94% versus PT from a payer perspective, and in 75% versus IMRT and 96% versus PT from a societal perspective (all costs in 2011 US dollars). The study reports no incremental cost-effectiveness ratio values.
What to keep in mind
The conclusion is conditional on the assumption of equivalent long-term efficacy across modalities, the study does not state the particle therapy or comparator costs it assumed, and the costs are in 2011 US dollars from secondary sources.
The figures it reported
This study reports no incremental cost-effectiveness ratio. That is not an omission in our table: some evaluations report dominance, a cost per life-year, or a decision-analytic result instead, and the summary above says which.
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical cohort of 65-year-old males with localized prostate cancer who declined or were ineligible for surgery and are eligible for external radiation therapies
- Comparator
- intensity-modulated radiation therapy (IMRT); stereotactic body radiation therapy (SBRT) is the index strategy
- Indication
- localized prostate cancer
- Study design
- Cost-utility analysis; lifetime Markov model; outcome measure quality-adjusted life years (QALYs); probabilistic and one-way sensitivity analyses
- Time horizon
- lifetime
- Delivery technique
- not reported by this study
- Perspective
- payer and societal
- Currency
- US$
- Price year
- 2011 US dollars
- Willingness-to-pay threshold
- US$ 50,000 per QALY
- Discount rate
- 3.0% annually for costs and utilities
- Cost of the particle course assumed
- not reported by this study
- Cost of the comparator assumed
- not reported by this study
Whose costs were counted: a payer, a hospital, or society as a whole.
The year the costs are expressed in. Without it, a figure cannot be compared across time.
The condition attached to the finding
Conclusion holds under the assumption that each modality yields equivalent long-term efficacy; SBRT cost-effective in 75% (vs IMRT) and 94% (vs PT) of simulations from payer perspective, and 75% and 96% from societal perspective at US$50,000/QALY; SBRT less expensive with better outcomes vs IMRT at toxicity rates up to 23% above SBRT base case.
Reporting quality
92 out of 100 on the Quality of Health Economic Studies instrument, a 16-item checklist covering the objective, the perspective, the sources of each estimate, the handling of uncertainty, the horizon and discounting, how costs were measured, the model's transparency, the discussion of bias, and whether funding was disclosed. It measures how well the study was reported, not whether its conclusion is correct: a well-reported study can still reach a conclusion a later trial overturns.