Mailhot Vega et al 2021
Int J Radiat Oncol Biol Phys · 2021 · United States · Proton
This US cost-utility study, taken from a societal perspective, used a Markov cohort model of a hypothetical group of 30-year-old adults with mediastinal Hodgkin lymphoma to compare proton therapy with photon intensity modulated radiation therapy (IMRT). The model ran over a lifetime, terminated at 80 years of age, and assumed a proton course cost of US$ 37,488 against US$ 16,104 for IMRT. The study concluded that proton therapy was not cost-effective in the base case, but might be cost-effective depending on the reduction in mean heart dose, age and sex.</summary> <parameter name="what_it_compared">The study compared proton therapy with photon IMRT in a hypothetical cohort of 30-year-old adults with mediastinal Hodgkin lymphoma, modelled over a lifetime.
What it compared
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What it found
In the base case the incremental cost-effectiveness ratio was US$129,000 per QALY for a male patient and US$196,000 per QALY for a female patient. The study judged these against willingness-to-pay thresholds of US$100,000/QALY and US$200,000/QALY.
What to keep in mind
The price year is not stated, the discount rate is not stated, and the results rest on a modelled hypothetical cohort with a quality score of 80, so the figures should be read as model outputs rather than observed costs.
The figures it reported
- $129,000 per QALYBase case, male patient (30-year-old)
- $196,000 per QALYBase case, female patient (30-year-old)
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical cohort of 30-year-old adults with mediastinal Hodgkin lymphoma
- Comparator
- Photon intensity modulated radiation therapy (IMRT)
- Indication
- Mediastinal Hodgkin lymphoma
- Study design
- Cost-utility analysis using a Markov cohort model
- Time horizon
- Lifetime, terminated at 80 years of age
- Delivery technique
- not reported by this study
- Perspective
- Societal
- Currency
- US$
- Price year
- not reported by this study
- Willingness-to-pay threshold
- US$100,000/QALY and US$200,000/QALY
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- US$ 37,488
- Cost of the comparator assumed
- US$ 16,104
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
Not cost-effective in the base case; may be cost-effective depending on mean heart dose reduction, age and sex. At WTP US$100,000/QALY proton therapy cost-effective in 25% of women and 48% of men; at WTP US$200,000/QALY in 50% of women and 65% of men. A 5-Gy MHD decrease was associated with ICER <$100,000/QALY in 40% of scenarios.
Reporting quality
80 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.