Sher et al 2018
Int J Radiat Oncol Biol Phys · 2018 · United States · Proton
This cost-utility study modelled proton beam therapy against intensity modulated radiation therapy (IMRT) for stage III to IVB oropharyngeal squamous cell carcinoma in the United States, using a Markov cohort model with two hypothetical cohorts of 65-year-old patients, one HPV-positive and one HPV-negative, each simulated 50,000 times over a lifetime horizon. Incremental cost-effectiveness ratios were reported from both payer and societal perspectives. The study concluded that proton therapy was not cost-effective at the stated willingness-to-pay threshold of US$100,000 per QALY. The assumed costs were US$27,192 for proton therapy and US$56,659 for the comparator.
What it compared
Proton beam therapy compared with intensity modulated radiation therapy in hypothetical cohorts of 65-year-old patients with stage III to IVB HPV-positive or HPV-negative oropharyngeal squamous cell carcinoma.
What it found
The incremental cost per QALY was US$288,000 for HPV-positive disease from the payer perspective, US$390,000 for HPV-positive disease from the societal perspective, US$516,000 for HPV-negative disease from the payer perspective and US$695,000 for HPV-negative disease from the societal perspective, all judged against a willingness-to-pay threshold of US$100,000 per QALY.
What to keep in mind
The price year for the costs is not stated, the discount rate is not reported in the paper, and the results rest on a modelled cohort with assumed costs (US$27,192 for proton therapy and US$56,659 for IMRT) rather than observed trial data, so the figures should be read with those assumptions in mind.
The figures it reported
- US$288,000 per QALYHPV-positive OPC, payer perspective
- US$390,000 per QALYHPV-positive OPC, societal perspective
- US$516,000 per QALYHPV-negative OPC, payer perspective
- US$695,000 per QALYHPV-negative OPC, societal perspective
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Two hypothetical cohorts of 65-year-old patients (HPV-positive and HPV-negative), simulated 50,000 times
- Comparator
- IMRT (intensity modulated radiation therapy)
- Indication
- Stage III-IVB oropharyngeal squamous cell carcinoma (HPV-positive and HPV-negative)
- Study design
- Cost-utility analysis using a Markov cohort model (hypothetical cohorts simulated 50,000 times)
- Time horizon
- Lifetime
- Delivery technique
- IMPT
- Perspective
- Payer and societal
- Currency
- US$
- Price year
- not reported by this study
- Willingness-to-pay threshold
- US$100,000/QALY
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- US$27,192
- Cost of the comparator assumed
- US$56,659
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
80 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.