Austin et al 2020
J Med Radiat Sci · 2020 · Australia · Proton
This Australian cost-utility study from a societal perspective modelled 16 left-sided breast cancer patients, each previously treated with conventional radiotherapy and replanned with intensity-modulated proton therapy (IMPT) and with intensity-modulated photon therapy (IMRT) using deep inspiration breath-hold. Dosimetric data were used to estimate tumour control and toxicity probabilities, which fed a Markov model of costs and quality-adjusted life years over a lifetime horizon. The authors concluded that proton therapy was cost-effective only for selected patients in whom IMRT delivered a significantly greater dose to normal tissue, and thus a greater reduction in second malignancy risk with IMPT.
What it compared
IMPT proton therapy against IMRT with deep inspiration breath-hold, in 16 left-sided breast cancer patients modelled in a Markov cohort analysis.
What it found
The average incremental cost-effectiveness ratio across the 16-patient cohort was AU$84,600 per QALY, judged against a willingness-to-pay threshold of 20,000 Pounds (estimated at AUD $36,000) per QALY.
What to keep in mind
The price year is not stated, the discount rate is not reported, the analysis models outcomes from dosimetry in a small cohort of 16 patients rather than observed outcomes, and the quality score (QHES) of 64 is moderate.
The figures it reported
- AU$84,600 per QALYAverage ICER across the 16-patient cohort
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
- 16 left-sided breast cancer patients (median age 56 years) previously treated with conventional radiotherapy and replanned with proton therapy
- Comparator
- Intensity-modulated photon therapy (IMRT/X-ray) with deep inspiration breath-hold (DIBH)
- Indication
- Left-sided breast cancer
- Study design
- Cost-utility analysis using a Markov cohort model
- Time horizon
- Until deceased state (lifetime)
- Delivery technique
- IMPT
- Perspective
- Societal perspective
- Currency
- AUD
- Price year
- not reported by this study
- Willingness-to-pay threshold
- 20,000 Pounds (est. AUD $36,000) per QALY
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- AUD 31,040 – AUD 39,040 (includes cost of complications)
- Cost of the comparator assumed
- AUD 13,410 – AUD 22,540 (includes cost of complications)
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
Proton therapy was not cost-effective for the majority of patients (only 1 of 16 was more cost-effective than X-ray); IMPT was cost-effective only for selected patients where IMRT resulted in a significantly greater dose to normal tissue, i.e. where there was a greater risk reduction of second malignancies with IMPT.
Reporting quality
64 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.