Yoshimura et al 2021
J Radiat Res · 2021 · Japan · Proton
This cost-utility study by Yoshimura and colleagues, published in J Radiat Res in 2021, modelled proton therapy against conventional X-ray (photon) therapy for paediatric medulloblastoma in Japan. It used a Markov cohort model of a hypothetical group of patients below 14 years old, taken from the payer's perspective with costs estimated from medical fees. The study expressed its result as cost per lifetime attributable risk (LAR) of radiation-induced secondary cancer and judged the proton strategy cost-effective. The abstract was not stored with the paper, so the wording above relies on the structured table entry alone.
What it compared
Proton therapy against conventional X-ray (photon) therapy in a hypothetical cohort of paediatric medulloblastoma patients below 14 years old.
What it found
The incremental cost-effectiveness ratio was JPY 3,856,398 per lifetime attributable risk of secondary cancer. The study does not state a willingness-to-pay threshold against which this figure was judged.
What to keep in mind
The price year for the costs is not stated, the outcome is a modelled risk measure rather than observed survival or quality of life, the time horizon is given as lifetime in the appendix but as 7.7 years in the abstract, and the quality score recorded for the study is 67.
The figures it reported
- JPY 3,856,398 per lifetime attributable risk (LAR) of secondary cancer
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 pediatric medulloblastoma patients below 14 years old
- Comparator
- Conventional X-ray (photon) therapy
- Indication
- Medulloblastoma (pediatric)
- Study design
- Cost-utility analysis using a Markov cohort model (as recorded in appendix); outcome is cost per lifetime attributable risk (LAR) of radiation-induced secondary cancer
- Time horizon
- Lifetime (appendix); the abstract states a 7.7-year time horizon after treatment
- Delivery technique
- not reported by this study
- Perspective
- Payer perspective (health care payers; costs estimated from medical fees)
- Currency
- JPY
- Price year
- not reported by this study
- Willingness-to-pay threshold
- not reported by this study
- Discount rate
- 2% annually (base case); other discount rates varied in sensitivity analysis
- Cost of the particle course assumed
- JPY 661,680 (as recorded in appendix; abstract gives total proton-arm cost of JPY 2,436,061)
- Cost of the comparator assumed
- JPY 2,375,000 (as recorded in appendix; abstract gives total X-ray-arm cost of JPY 1,067,608)
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
67 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.