Mailhot Vega et al 2015
Cancer · 2015 · United States · Proton
This cost-utility study used a Markov cohort model to compare proton therapy with photon therapy (conventional radiation therapy or IMRT) for pediatric brain tumours, focusing on the risk of growth hormone deficiency driven by the radiation dose to the hypothalamus. The analysis was run from a United States health system perspective over a lifetime horizon, using a hypothetical cohort of 4-year-old and 12-year-old patients. The study concluded that proton therapy was cost effective under conditional circumstances, namely where it lowers the hypothalamic dose relative to photons.
What it compared
Proton therapy against photon therapy (conventional radiation therapy or IMRT) in a hypothetical cohort of 4-year-old and 12-year-old children with brain tumours, modelled from a US health system perspective.
What it found
The study does not report a single headline ICER value. The study judged proton therapy against a willingness-to-pay threshold of US$50,000 per QALY, and proton therapy was cost effective in scenarios where it lowered the hypothalamic dose, in some cases being cost saving (ICER below 1). The proton therapy cost premium assumed was US$160,000 more than photon therapy, in 2012 US$.
What to keep in mind
The results are conditional on the hypothalamic dose difference, the cohort is hypothetical rather than drawn from real patients, the discount rate is not stated in the paper, and the 2012 US$ price year may not reflect current costs.
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 4-year-old and 12-year-old pediatric patients
- Comparator
- Photon therapy (conventional radiation therapy / IMRT)
- Indication
- Central nervous system tumors (pediatric brain tumors; risk of growth hormone deficiency from hypothalamic dose)
- Study design
- Cost-utility analysis using a Markov cohort model
- Time horizon
- Lifetime
- Delivery technique
- not reported by this study
- Perspective
- Health system perspective
- Currency
- US$
- Price year
- 2012 US$
- Willingness-to-pay threshold
- US$50,000 / QALY
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- US$160,000 more than photon
- Cost of the comparator assumed
- Comparator (photon cost is the baseline; no separate figure given)
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
Proton therapy was cost effective in scenarios where proton therapy lowers the radiation dose to the hypothalamus compared with IMRT/photons (in some cases cost saving, ICER below 1). It may not be cost effective when tumors involve or are directly adjacent to the hypothalamus and the dose to it is high.
Reporting quality
83 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.