Hirano et al 2014
J Radiat Res · 2013 · Japan · Proton
This cost-utility study modelled a hypothetical cohort of 6-year-old children with medulloblastoma in Japan, comparing proton beam therapy with cochlear dose reduction against conventional X-ray radiotherapy. A Markov model estimated the risk of hearing loss from cochlear dose for each treatment, and quality-adjusted life years were estimated using three health-related quality of life instruments (EQ-5D, HUI3 and SF-6D) over a lifetime horizon. The authors concluded that proton therapy was cost-effective, improving health outcomes at a cost within the acceptable range.
What it compared
Proton beam therapy with cochlear dose reduction versus conventional X-ray radiotherapy for medulloblastoma, in a modelled cohort of 6-year-old children.
What it found
The incremental cost-effectiveness ratios were US$21,716 per QALY using EQ-5D, US$11,773 per QALY using HUI3 and US$20,150 per QALY using SF-6D. The willingness-to-pay threshold used was US$46,729 per QALY, and the study reports a 99% probability of proton therapy being cost-effective at a societal willingness-to-pay value.
What to keep in mind
The price year is not stated, the discount rate is not stated, the cohort is modelled rather than observed, the costs are from a single assumed proton cost (US$26,943) and comparator cost (US$3,082), and the study gives a quality score of 92 but the study's perspective is labelled as the patient's while the abstract refers to the payer's standpoint.
The figures it reported
- $21,716 per QALYEQ-5D
- $11,773 per QALYHUI3
- $20,150 per QALYSF-6D
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical cohort of 6-year-old patients with medulloblastoma
- Comparator
- Conventional X-ray radiotherapy
- Indication
- Medulloblastoma (pediatric)
- Study design
- Cost-utility analysis using a Markov cohort model
- Time horizon
- Lifetime
- Delivery technique
- not reported by this study
- Perspective
- Patient perspective
- Currency
- US$
- Price year
- not reported by this study
- Willingness-to-pay threshold
- US$ 46,729 / QALY
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- US$ 26,943
- Cost of the comparator assumed
- US$ 3,082
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.
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.