Li et al 2022
Prostate · 2022 · China · Proton
This cost-utility study from China, published in Prostate in 2022, used a Markov cohort model to compare proton stereotactic body radiation therapy with photon-based SBRT for localised prostate cancer. The analysis took a societal perspective and a time horizon running to 80 years of age, in a hypothetical cohort with a median age of 66 years and normal pretreatment erectile function. The base-case incremental cost-effectiveness ratio was US$47,456 per QALY, which is above the Chinese societal willingness-to-pay threshold of US$37,653 per QALY, so the study judged proton SBRT not cost-effective for the median patient at that threshold. The study concluded that proton SBRT is cost-effective only under certain conditions, which depend on patient age, proton cost and life expectancy.
What it compared
Proton SBRT against photon-based SBRT for localised prostate cancer in a hypothetical cohort with a median age of 66 years, modelled from a Chinese societal perspective.
What it found
The base-case ICER was US$47,456 per QALY, against the Chinese societal willingness-to-pay threshold of US$37,653 per QALY. When the proton cost was varied from US$15,433 to US$20,560, the ICER ranged from US$30,612 to US$64,253 per QALY.
What to keep in mind
The conclusion is conditional: proton SBRT is cost-effective at the Chinese threshold only for patients aged 62 years or younger, or for median-age patients if the proton cost falls to US$16,505.7 or below or life expectancy is 88 years or more. The price year is not stated, the discount rate is not stated, and the results rest on a modelled cohort with assumed costs of US$18,000 for proton SBRT and US$8,000 for SBRT.
The figures it reported
- US$47,456 per QALYBase case (66-year-old, proton SBRT vs photon SBRT)
- US$30,612 – US$64,253 per QALYProton cost varied from US$15,433 to US$20,560
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical cohort of localized prostate cancer patients, median age 66 years, with normal pretreatment erectile function
- Comparator
- Photon-based stereotactic body radiation therapy (SBRT)
- Indication
- Localized prostate cancer
- Study design
- Cost-utility analysis using a Markov cohort model
- Time horizon
- Until 80 years of age
- Delivery technique
- not reported by this study
- Perspective
- Societal
- Currency
- US$
- Price year
- not reported by this study
- Willingness-to-pay threshold
- US$37,653/QALY (Chinese societal WTP threshold); also US$50,000/QALY and US$100,000/QALY examined
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- US$18,000 (proton SBRT)
- Cost of the comparator assumed
- US$8,000 (SBRT)
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 SBRT is cost-effective for patients ≤62 years at China's WTP (≤66 years at US$50,000/QALY; ≤73 years at US$100,000/QALY). For median-age patients, it is cost-effective if the proton cost falls to ≤US$16,505.7 or life expectancy is ≥88 years. Not cost-effective in the base case at the Chinese WTP (ICER US$47,456/QALY).
Reporting quality
73 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.