Fernandes et al 2019
Value Health Reg Issues · 2019 · Brazil · Proton
This cost-utility study from Brazil, published in 2019 in Value in Health Regional Issues, used a Markov cohort model to compare proton therapy with conventional photon radiation therapy for a hypothetical cohort of 5-year-old children with medulloblastoma. It took a Brazilian health system perspective, a lifetime horizon and a 3% discount rate, and varied the number of patients treated per year across 50, 100 and 150 scenarios with a 20-year equipment life span. The study concluded that proton therapy was not cost-effective at the willingness-to-pay threshold it used.
What it compared
The study compared proton therapy with conventional photon radiation therapy in a hypothetical cohort of 5-year-old paediatric medulloblastoma patients, modelled at volumes of 50, 100 and 150 patients per year.
What it found
The base-case incremental cost-effectiveness ratio was $34,390 per QALY at 50 patients per year, falling to $15,098 per QALY at 100 patients per year and 9,135 per QALY at 150 patients per year (the study reports no currency symbol for this last figure). All were judged against a threshold of $8,649 per QALY, described in the abstract as one GDP per capita, and the study concluded that proton therapy was not cost-effective.
What to keep in mind
The study does not state the price year for the costs, the particle therapy and photon costs are given without units in the appendix, and the cohort is modelled rather than drawn from real patients; the study also has a quality score of 70, and the 9,135 figure is recorded without a currency symbol.
The figures it reported
- $34,390 per QALYBase case: 50 patients/year, 20-year equipment life span
- $15,098 per QALY100 patients/year, 20-year equipment life span
- 9,135 per QALY150 patients/year, 20-year equipment life span
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 5-year-old pediatric medulloblastoma patients; volume scenarios of 50, 100 and 150 patients treated per year
- Comparator
- Conventional photon radiation therapy
- Indication
- Pediatric medulloblastoma
- Study design
- Cost-utility analysis using a Markov cohort model
- Time horizon
- Lifetime (until death)
- Delivery technique
- not reported by this study
- Perspective
- Health system perspective (Brazilian)
- Currency
- $ (currency not specified beyond the symbol)
- Price year
- not reported by this study
- Willingness-to-pay threshold
- $8,649 / QALY (the abstract describes this as 1 GDP per capita)
- Discount rate
- 3%
- Cost of the particle course assumed
- $206,299 (appendix gives no unit)
- Cost of the comparator assumed
- $112,135 (appendix gives no unit)
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.
Capital cost assumption
- What it assumed
- The entire capital investment of the proton center is amortised over the patients treated. The center is assumed to treat only pediatric medulloblastoma. Base case is 50 patients/year and 20-year equipment life span; sensitivity analyses use 100 and 150 patients/year and other equipment life spans. No monetary capital figure is given in the appendix.
- Where that figure came from
- not reported by this study
Reporting quality
70 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.