Jensen et al 2019
Radiation oncology (London, England) · 2019 · Germany · Carbon ion
This study assessed the cost-effectiveness of adding a carbon ion (C12) boost to intensity-modulated radiotherapy (IMRT) for adenoid cystic carcinoma of the head and neck, using patient-level data from a German setting. Costs were taken from resource use recorded in individual patient charts and adjusted for censoring using the Lin I method, with outcomes expressed as life-years gained. The treatment increased overall costs by €18,076 (€13,416 to €22,922) for a mean survival benefit of 0.86 years. The authors concluded that the combined treatment substantially increased initial and overall treatment cost, but that costs may be acceptable given the limited treatment options in this disease.
What it compared
IMRT plus C12 boost, given within C12 treatment slots, compared with IMRT alone in patients with pathologically confirmed adenoid cystic carcinoma who presented outside those slots, analysed from a healthcare purchaser's perspective.
What it found
The base-case incremental cost-effectiveness ratio was 26,863 €/LY (euros per life-year, 2015 prices). After accounting for different management of recurrent disease between the two cohorts, it was 20,638 €/LY. The study does not state a willingness-to-pay threshold.
What to keep in mind
The study is conditional on how recurrent disease was managed, the price year is 2015 with inflation not considered, the time horizon is simply the available follow-up, and the two groups were not randomised, being defined by whether patients presented within C12 treatment slots.
The figures it reported
- 26,863 €/LY per life-year (LY)Base case: IMRT+C12 boost vs IMRT only
- 20,638 €/LY per life-year (LY)Sensitivity analysis accounting for different management of recurrent disease
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
- Patients with pathologically confirmed ACC receiving IMRT plus C12 boost (within C12 treatment slots) vs IMRT only (patients presenting outside C12 slots)
- Comparator
- IMRT only
- Indication
- Adenoid cystic carcinoma (ACC) of the head and neck
- Study design
- Cost-effectiveness analysis on patient-level data; cost histories from patient charts adjusted for censoring with Lin I method; outcome measured as life-years gained (ICER per LY)
- Time horizon
- Duration of available follow-up (no fixed horizon stated)
- Delivery technique
- IMRT plus C12 boost (carbon ion boost); technique within carbon boost not stated
- Perspective
- healthcare purchaser's perspective
- Currency
- EUR
- Price year
- 2015 (costs in € at 2015 price level; inflation not considered)
- Willingness-to-pay threshold
- not reported by this study
- Discount rate
- 3.5% and 3.0% (both costs and effects discounted equally)
- Cost of the particle course assumed
- €14,000 (flat fee for C12 radiotherapy reimbursement)
- Cost of the comparator assumed
- €5,675.27 (total cost of standard treatment)
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
Sensitivity analysis for differing management of recurrent disease in the two cohorts; ICER 26,863 €/LY base case and 20,638 €/LY after accounting for recurrent disease management
Reporting quality
86 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.