Moriarty et al 2015
PloS one · 2015 · United States · Proton
This US cost-utility study modelled proton beam therapy for intraocular melanoma against enucleation (the reference) and plaque brachytherapy. It used a Markov model over a five-year horizon, with a hypothetical cohort of 10,000 simulated patients aged 59 at model start, repeated 1,000 times per arm, and took a provider perspective counting direct medical costs only. In the base case enucleation was the optimal choice, but the authors judged the result unstable under one-way sensitivity analyses, where all three treatments could be optimal or even dominant depending on parameter values.
What it compared
Proton beam therapy and plaque brachytherapy, each compared with enucleation as the reference, in a simulated cohort of patients with intraocular melanoma.
What it found
The base-case incremental cost-effectiveness ratios were US$77,500 per quality-adjusted life-year for plaque brachytherapy and US$106,100 per quality-adjusted life-year for proton beam therapy, both against enucleation. The study used a threshold of US$50,000 per QALY.
What to keep in mind
Proton beam therapy sat above the US$50,000 per QALY threshold in the base case, the price year is 2011, the horizon is only five years, the cohort is simulated, and the particle and comparator costs are not stated in the paper, so the result depends heavily on parameter values the study itself found highly sensitive.
The figures it reported
- $77,500 per quality-adjusted life-yearPlaque brachytherapy vs enucleation (base case)
- $106,100 per quality-adjusted life-yearProton beam therapy vs enucleation (base case)
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical cohort of 10,000 simulated patients, 59 years old at model start, repeated 1,000 times per treatment arm
- Comparator
- Enucleation (reference); plaque brachytherapy
- Indication
- Intraocular melanoma
- Study design
- Cost-utility analysis; Markov model; outcome measured in quality-adjusted life-years (QALYs); one-way sensitivity analyses on all parameters
- Time horizon
- Five years (model cycle = one year)
- Delivery technique
- not reported by this study
- Perspective
- Provider perspective (direct medical costs only)
- Currency
- US$
- Price year
- 2011
- Willingness-to-pay threshold
- US$50,000 per QALY
- Discount rate
- 3% for future costs and 3% for future QALYs
- 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
Base case favours enucleation (PBT ICER above threshold), but results were highly sensitive to multiple parameters; depending on parameter values, all three treatments could be optimal or dominant, and both plaque brachytherapy and proton beam therapy could be considered cost-effective.
Reporting quality
77 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.