Austin et al 2019
Australas Phys Eng Sci Med · 2019 · Australia · Proton
This Australian cost-utility analysis compared proton therapy with conventional photon radiotherapy (VMAT, per the abstract) for base of skull chordoma, taking a societal perspective and a lifetime horizon. It used a Markov cohort model built on comparative treatment plans for seven patients who had previously been treated with conventional radiotherapy, aged 4, 6, 8, 12, 27, 46 and 51 years. The study concluded that proton therapy was cost-effective. All seven patients had an incremental cost-effectiveness ratio below AU$20,170 per QALY, and two of the seven were cost-saving (negative ICER). The threshold used was AU$36,000 to AU$54,000 per QALY.
What it compared
Proton therapy against conventional photon radiotherapy (VMAT per the abstract) for seven patients with base of skull chordoma, modelled from comparative treatment plans.
What it found
The incremental cost-effectiveness ratio was below AU$20,170 per QALY for all seven patients, and negative (cost-saving) for two of them, judged against a willingness-to-pay threshold of AU$36,000 to AU$54,000 per QALY.
What to keep in mind
The price year is not stated, the discount rate is not reported, the cohort is only seven modelled patients from treatment plans rather than observed outcomes, and the proton cost was assumed as AU$11,877 multiplied by 2.5, so the result depends heavily on that assumption.
The figures it reported
- below 20,170 per QALY (currency as AU$; written without symbol in appendix)all 7 patients, proton vs conventional radiation therapy
- negative ICER (cost-saving) per QALY2 of 7 patientsDominant: cheaper and more effective than the comparator, so there is no ratio to quote.
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
- 7 patients previously treated with conventional radiation therapy, aged 4, 6, 8, 12, 27, 46 and 51 years
- Comparator
- Conventional photon radiotherapy (VMAT per abstract)
- Indication
- Base of skull chordoma
- Study design
- Cost-utility analysis using a Markov cohort model, based on comparative treatment plans for 7 patients
- Time horizon
- Lifetime
- Delivery technique
- IMPT
- Perspective
- Societal
- Currency
- AU$
- Price year
- not reported by this study
- Willingness-to-pay threshold
- AU$36,000 – AU$54,000 / QALY
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- AU$11,877 x 2.5
- Cost of the comparator assumed
- AU$11,877
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
73 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.