Ramaekers et al 2012
Int J Radiat Oncol Biol Phys · 2012 · Netherlands · Proton
This Dutch cost-utility study compared proton beam therapy with photon intensity-modulated radiotherapy (IMRT) for head and neck cancer, using a Markov cohort model with normal tissue complication probability (NTCP)-based estimates of complications, from a healthcare perspective and over a lifetime horizon. The modelled cohort had 25 patients with an average age of 61 years. The study concluded that proton therapy is cost-effective only when it is targeted at patients for whom it is efficient, rather than being given to all patients.
What it compared
Intensity-modulated proton therapy, given either to all patients or only to those for whom it is efficient, against photon IMRT for all patients with head and neck cancer, in a modelled cohort of 25 patients averaging 61 years of age.
What it found
In the base case, the "IMPT if efficient" strategy had an incremental cost-effectiveness ratio of EUR 60,278 per QALY gained, under the EUR 80,000 per QALY threshold, while IMPT for all had EUR 127,946 per QALY gained and was not cost-effective.
What to keep in mind
The base case assumes equal survival between the two modalities, and when this assumption was relaxed in sensitivity analysis IMRT for all became the most cost-effective strategy; the price year is not stated, the discount rate is not stated, and the cost inputs (EUR 21,100 for particle therapy and EUR 10,048 for the comparator) come from a modelled rather than observed cohort.
The figures it reported
- EUR 60,278 per QALY gainedIMPT if efficient vs IMRT for all (base case)
- EUR 127,946 per QALY gainedIMPT for all (base case)
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
- 25 patients, average age 61 years
- Comparator
- Photon IMRT (conventional radiation therapy) for all patients
- Indication
- Head and neck cancer
- Study design
- Cost-utility analysis using a Markov cohort model with NTCP-based complication estimates
- Time horizon
- Lifetime
- Delivery technique
- IMPT
- Perspective
- Healthcare perspective
- Currency
- EUR
- Price year
- not reported by this study
- Willingness-to-pay threshold
- EUR 80,000 per QALY
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- EUR 21,100
- Cost of the comparator assumed
- EUR 10,048
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
In the base case (equal survival assumed), IMPT is cost-effective only when targeted at patients for whom it is efficient (the 'IMPT if efficient' strategy, ICER EUR 60,278/QALY, under the EUR 80,000 threshold). IMPT for all (ICER EUR 127,946/QALY) is not cost-effective. When the equal-survival assumption is relaxed in the sensitivity analysis, IMRT for all is the most cost-effective strategy.
Reporting quality
85 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.