Li et al 2020
BMC Cancer · 2020 · China · Proton
This study used a three-state Markov cohort model from a societal perspective to compare intensity-modulated proton beam therapy (IMPT) with intensity-modulated photon radiation therapy (IMRT) for paranasal sinus and nasal cavity cancers in China. The model used a hypothetical 47-year-old patient, the median age of patients with these cancers in China, over a 30-year horizon. The authors concluded that IMPT could still be cost-effective for these patients in China, with the condition that it is cost-effective only in patients aged 56 or younger at the China willingness-to-pay threshold.
What it compared
The study compared IMPT with IMRT in a hypothetical cohort of 47-year-old patients with paranasal sinus and nasal cavity cancers in a Chinese setting.
What it found
In the base case, IMPT gained 1.65 QALYs at an additional cost of US$38,928.7 compared with IMRT, giving an ICER of US$23,611.2 per QALY, below the China societal willingness-to-pay threshold of US$30,828 per QALY.
What to keep in mind
The study does not state the price year or the discount rate, the costs are assumed rather than observed (particle cost US$50,000 and comparator cost US$12,000), and the result rests on a modelled cohort, so the cost-effectiveness depends heavily on the age cut-off and on the assumed tumour control probabilities.
The figures it reported
- US$23,611 per QALYBase case: IMPT vs IMRT, 47-year-old patient
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical patient aged 47 years (median age of patients with paranasal sinus and nasal cavity cancers in China)
- Comparator
- Intensity-modulated photon radiation therapy (IMRT)
- Indication
- Paranasal sinus and nasal cavity cancers
- Study design
- Cost-utility analysis using a 3-state Markov cohort model (no cancer, alive with cancer, death)
- Time horizon
- 30 years
- Delivery technique
- IMPT
- Perspective
- Societal
- Currency
- US$
- Price year
- not reported by this study
- Willingness-to-pay threshold
- US$30,828 / QALY
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- US$50,000
- Cost of the comparator assumed
- US$12,000
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
IMPT is cost-effective for patients <56 years old at a WTP of US$30,828/QALY, <66 years old at a WTP of US$50,000/QALY, and <71 years old at a WTP of US$100,000/QALY. The abstract gives the age limit at the China WTP as ≤56 years. The abstract also lists independent conditions: probability of IMPT eradicating cancer ≥0.867, probability of IMRT eradicating cancer ≤0.764, or IMPT cost ≤ $52,163.9.
Reporting quality
79 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.