Okazaki et al 2022
Cancer science · 2022 · Japan · Carbon ion
This Japanese study compared carbon-ion radiotherapy (CIRT) with stereotactic body radiotherapy (SBRT) for clinical stage I non-small-cell lung cancer, using retrospective data from Gunma University for patients treated between 2010 and 2015. The analysis included 62 CIRT and 27 SBRT patients, and after propensity-score matching 15 patients per group, with outcomes expressed as life years over five years after treatment. The authors concluded that CIRT is cost-effective, while suggesting that reducing excess examination and hospitalisation costs could make it more cost-effective still.
What it compared
Carbon-ion radiotherapy against stereotactic body radiotherapy for patients with clinical stage I non-small-cell lung cancer treated at a single Japanese university centre.
What it found
The incremental cost-effectiveness ratio was 7,491,017 JPY per life year for all patients and 3,708,330 JPY per life year for propensity-score matched patients. The study gives two willingness-to-pay thresholds, 4,000,000 JPY and 8,000,000 JPY, against which the ICERs were judged, and the study concludes CIRT is cost-effective.
What to keep in mind
The costs are from a single centre with no price year or discount rate stated, the perspective is not stated, the horizon is only five years, and the matched comparison rests on just 15 patients per group drawn from a retrospective cohort.
The figures it reported
- 7,491,017 JPY/LY per life year (LY)All patients
- 3,708,330 JPY/LY per life year (LY)Propensity-score matched patients
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 clinical stage I NSCLC treated at Gunma University 2010-2015: 62 CIRT and 27 SBRT patients; after propensity-score matching 15 per group (all patients and matched patients analysed).
- Comparator
- Stereotactic body radiotherapy (SBRT)
- Indication
- Clinical stage I non-small-cell lung cancer (NSCLC)
- Study design
- Cost-effectiveness analysis using retrospective patient data (propensity-score matched cohorts); outcome measure life years (LY); incremental cost divided by incremental LY. Not described as a Markov or decision-tree model.
- Time horizon
- 5 years after treatment
- Delivery technique
- not reported by this study
- Perspective
- not reported by this study
- Currency
- JPY
- Price year
- not reported by this study
- Willingness-to-pay threshold
- 4 000 000 JPY and 8 000 000 JPY (willingness-to-pay thresholds for ICER, acceptability curves)
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- CIRT technical fee 3,140,000 JPY (no technical fee for a second CIRT on the same organ within 2 years)
- Cost of the comparator assumed
- SBRT mean total cost 1 717 238 JPY for all patients and 1 428 994 JPY for matched patients
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
71 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.