Li et al 2021
Head Neck · 2021 · China · Proton
This cost-utility study, set in China from a societal perspective, modelled intensity-modulated proton therapy (IMPT) against conventional intensity-modulated photon radiation therapy (IMRT) for a hypothetical 43-year-old, median-age patient with T2N2M0 nasopharyngeal carcinoma. A Markov model over a lifetime horizon assumed that IMPT would reduce normal tissue complication probability for long-term dysphagia, xerostomia and hearing loss. The authors concluded that IMPT has potential to be cost-effective for average Chinese patients with this cancer, provided the NTCP reduction is large enough, and that this should be validated clinically.
What it compared
The study compared proton therapy (IMPT) with photon IMRT for a simulated 43-year-old patient with T2N2M0 nasopharyngeal carcinoma, from a Chinese societal perspective.
What it found
Incremental cost-effectiveness ratios ranged from US$102,684 per QALY at a 10% NTCP reduction to US$4,436 per QALY at a 60% reduction, judged against a willingness-to-pay threshold of US$33,558 per QALY. The study reports that IMPT needs an NTCP reduction of at least 24% to be considered cost-effective.
What to keep in mind
The conclusion is conditional on the assumed NTCP reductions, which are modelled rather than measured clinically, and the study does not state the price year or the discount rate, while the particle therapy cost of US$50,000 and comparator cost of US$12,000 are assumptions in the model.
The figures it reported
- US$102,684 per QALY10% NTCP reduction (median age 43)
- US$43,161 per QALY20% NTCP reduction (median age 43)
- US$24,134 per QALY30% NTCP reduction (median age 43)
- US$13,991 per QALY40% NTCP reduction (median age 43)
- US$8,259 per QALY50% NTCP reduction (median age 43)
- US$4,436 per QALY60% NTCP reduction (median age 43)
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical patient aged 43 (median age) with T2N2M0 NPC, simulated with 50,000 iterations
- Comparator
- IMRT (intensity-modulated photon radiation therapy)
- Indication
- Nasopharyngeal carcinoma (T2N2M0)
- Study design
- Cost-utility analysis using a Markov cohort model (50,000 iterations)
- Time horizon
- Lifetime
- Delivery technique
- IMPT
- Perspective
- Societal
- Currency
- US$
- Price year
- not reported by this study
- Willingness-to-pay threshold
- US$33,558 / 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 only if it provides a sufficient NTCP reduction in long-term dysphagia, xerostomia and hearing loss: ≥24% for the median-age (43-year-old) patient (abstract). Appendix by-age figures: 10-year-old 17%, 20-year-old 19%, 30-year-old 20%, 40-year-old 24%, 50-year-old 28%, 60-year-old 39% NTCP reduction.
Reporting quality
92 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.