Hiroshima et al 2023
Cancer medicine · 2023 · Japan · Proton
This Japanese cost-utility study modelled proton beam therapy (PBT) against three-dimensional conformal radiotherapy (3DCRT), a conventional photon treatment, for unresectable locally advanced pancreatic cancer, taking the payers' perspective of Japan's social health insurance system. The model combined a decision tree with an economic and Markov model over a 60-month horizon, with effectiveness expressed as quality-adjusted life years (QALYs) and costs taken from social insurance fees. The authors concluded that PBT used as a replacement for photon radiotherapy is cost-effective, and that the base-case result was stable in one-way and probabilistic sensitivity analyses.
What it compared
The study compared proton beam therapy with 3DCRT (conventional photon radiotherapy) in a modelled cohort of hypothetical patients with unresectable locally advanced pancreatic cancer, from the payers' perspective in Japan.
What it found
The base-case ICER for PBT versus 3DCRT was ¥5,376,915 (US$46,756) per QALY, judged against the suggested Japanese threshold of ¥7,500,000 (US$65,217) per QALY gain, and so considered cost-effective. Effectiveness was 1.67610615 QALYs for PBT and 0.97181271 QALYs for 3DCRT.
What to keep in mind
The cohort is modelled rather than observed, the price year for the costs is not stated, the time horizon is only 60 months, and the costs reflect a single assumed reimbursable PBT fee of ¥2,375,000 (US$20,652) against ¥694,150 (US$6036) for 3DCRT, so the result depends heavily on these inputs and on expert-opinion-based assumptions.
The figures it reported
- ¥5,376,915 (US$46,756) per QALYPBT vs 3DCRT (base case)
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical patients with unresectable locally advanced pancreatic cancer (modelled cohort; age and stage details not stated)
- Comparator
- Three-dimensional conformal radiotherapy (3DCRT), a conventional photon RT
- Indication
- Unresectable locally advanced pancreatic cancer (LAPC)
- Study design
- Cost-utility analysis; decision tree combined with economic and Markov model; outcome QALY using health-state utility weights; one-way and probabilistic sensitivity analyses
- Time horizon
- 60 months (Markov model programmed to cease when the cohort reached the 60th month; 1-month cycles)
- Delivery technique
- not reported by this study
- Perspective
- Payers' perspective (direct medical costs borne by social insurers and patients in Japan's social health insurance system)
- Currency
- JPY (with US$ conversions given)
- Price year
- not reported by this study
- Willingness-to-pay threshold
- ¥7,500,000 (US$65,217) per QALY gain (suggested threshold for anti-cancer therapy from the Japanese authority)
- Discount rate
- 3% annual rate for costs and outcomes in the base case; 0% to 5% varied in sensitivity analysis
- Cost of the particle course assumed
- ¥2,375,000 (US$20,652) reimbursable fee for PBT (US$1 = ¥115)
- Cost of the comparator assumed
- ¥694,150 (US$6036) for 3DCRT
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
78 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.