Leung et al 2016
Oncotarget · 2017 · Taiwan · Proton
This Taiwanese cost-utility study compared proton beam therapy with stereotactic body radiation therapy (SBRT) for inoperable advanced hepatocellular carcinoma, using a Markov model built on time-to-progression and survival data from a phase II trial. The analysis took a societal perspective, used real direct medical costs from the Bureau of National Health Insurance database, and simulated a hypothetical cohort of 10,000 patients over a 5-year horizon. The authors concluded that proton beam therapy is cost-effective at Taiwan's willingness-to-pay threshold.
What it compared
Proton beam therapy against SBRT in a hypothetical cohort of patients with inoperable advanced hepatocellular carcinoma, modelled in Taiwan.
What it found
The base-case ICER was NT$ 213,354 per QALY gained, against a willingness-to-pay threshold of NT$ 2,157,024 (US$ 67,407) per QALY gained; the probabilistic sensitivity analysis gave a 97 % chance of proton beam therapy being cost-effective at that threshold. Proton beam therapy added 2.61 QALYs at an incremental cost of NT$ 557,907.
What to keep in mind
The price year for the costs is not stated, the discount rate is not reported, the survival inputs come from a phase II trial in a modelled rather than observed cohort, and the study's quality score is 76, so the result rests on model assumptions such as the assumed proton cost of NT$ 300,000 (US$ 9,375).
The figures it reported
- NT$ 213,354 per QALY gainedProton beam therapy vs SBRT, 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 patients, each simulated over 1000 times; age 69.4-70 years
- Comparator
- Stereotactic body radiation therapy (SBRT)
- Indication
- Hepatocellular carcinoma (inoperable advanced / large)
- Study design
- Cost-utility analysis using a Markov cohort model
- Time horizon
- 5 years
- Delivery technique
- not reported by this study
- Perspective
- Societal
- Currency
- NT$ (with US$ equivalents)
- Price year
- not reported by this study
- Willingness-to-pay threshold
- NT$ 2,157,024 (US$ 67,407) per QALY gained
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- NT$ 300,000 (US$ 9,375)
- Cost of the comparator assumed
- NT$ 213,660 (US$ 6,677) (SBRT)
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
76 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.