Jones et al 2023
Clinical oncology (Royal College of Radiologists (Great Britain)) · 2023 · UK · Proton
This cost-utility study used a microsimulation model of intermediate-stage Hodgkin lymphoma, background mortality and late effects to compare consolidative pencil beam scanning proton beam therapy with volumetric modulated arc therapy, both in deep-inspiration breath-hold, from a UK NHS perspective counting costs attributable to late effects. It used 606 illustrative patients spanning two age strata (20 and 40 years), both sexes, three smoking statuses and 61 pairs of organ-at-risk doses from a comparative planning study. The authors concluded that proton therapy for this indication may not be considered cost-effective in the UK, while noting that the uncertainty is substantial and not fully quantifiable.
What it compared
Consolidative pencil beam scanning proton beam therapy against volumetric modulated arc therapy in deep-inspiration breath-hold, in modelled illustrative patients with intermediate-stage Hodgkin lymphoma varying by age, sex, smoking status and organ-at-risk doses.
What it found
For the gain in discounted QALYs to be considered cost-effective, proton therapy would have to cost at most £4812 more than VMAT for current smokers and £645 more for never smokers, against a NICE threshold of £20,000–30,000 per QALY. The study reports the average discounted QALY gain as 0.146 for current smokers and 0.017 for never smokers.
What to keep in mind
The price year is 2014/15, the study does not state the assumed particle or comparator costs, the cohort is modelled rather than observed, and the study gives a quality score of 65, so the break-even figures should be read as tied to these assumptions and to the authors' acknowledged substantial uncertainty.
The figures it reported
This study reports no incremental cost-effectiveness ratio. That is not an omission in our table: some evaluations report dominance, a cost per life-year, or a decision-analytic result instead, and the summary above says which.
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
- 606 illustrative patients: two age strata (20 and 40 years), both sexes, three smoking statuses (never, former, current), 61 pairs of OAR doses from a comparative planning study
- Comparator
- Volumetric modulated arc therapy (VMAT), both in deep-inspiration breath-hold
- Indication
- Intermediate-stage Hodgkin lymphoma (ISHL)
- Study design
- Cost-utility analysis; microsimulation model of ISHL course, background mortality and late effects; outcome measure QALYs
- Time horizon
- Lifetime
- Delivery technique
- pencil beam scanning (PBS)
- Perspective
- UK National Health Service costs attributable to late effects
- Currency
- GBP
- Price year
- 2014/15
- Willingness-to-pay threshold
- £20,000–30,000 per QALY (NICE range); £30,000 per QALY used for the maximum excess cost of PBT
- Discount rate
- 3.5% yearly for both costs and outcomes (discounted outcomes analysed alongside undiscounted)
- Cost of the particle course assumed
- not reported by this study
- Cost of the comparator assumed
- not reported by this study
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
Conclusion is unconditional in the abstract ("may not be considered cost-effective"), but break-even excess cost differs by smoking status: at most £4812 more than VMAT for current smokers and £645 more for never smokers (discounted QALYs). Results vary by OAR dose pairs, age (20 and 40 years), sex and smoking status.
Reporting quality
65 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.