Okazaki et al 2024
Advances in radiation oncology · 2024 · Japan · Carbon ion
This Japanese cost-effectiveness analysis compared carbon-ion radiation therapy (CIRT) with transarterial chemoembolization (TACE) for localized hepatocellular carcinoma that was unsuitable for surgery or radiofrequency ablation. The analysis used a propensity-score-matched cohort of 34 patients treated at Gunma University between 2007 and 2016, with a time horizon of 1 month before treatment to 3 years after, and took the perspective of public health care payers. Life years were the outcome. CIRT was dominant over TACE, with a higher life-year estimate (2.75 vs 2.41) and a lower mean total cost (¥4,974,278 vs ¥5,284,524), and the authors concluded that CIRT is cost-effective for this group.
What it compared
Carbon-ion radiation therapy against transarterial chemoembolization in 34 propensity-score-matched patients with localized hepatocellular carcinoma ineligible for surgery or radiofrequency ablation, treated at Gunma University in Japan.
What it found
CIRT was dominant over TACE, with a higher point estimate of life years (2.75 vs 2.41) and lower mean total cost (¥4,974,278 vs ¥5,284,524, approximately 51,809 USD for TACE). The authors adopted a willingness-to-pay threshold of ¥4,000,000 per life year (approximately 39,216 USD), and CIRT acceptability exceeded 70% at this level in the probabilistic sensitivity analysis.
What to keep in mind
The price year is not stated, the discount rate is not reported, the cohort is only 34 patients from a single centre with retrospective propensity matching, and the sensitivity analyses show that the cost-effectiveness conclusion depends heavily on the assumed CIRT technical fee and the variance in TACE costs, with some scenarios giving ratios well above the stated threshold.
The figures it reported
- dominant (CIRT over TACE; higher LY and lower total cost, no ICER calculated) not applicableprimary analysisDominant: cheaper and more effective than the comparator, so there is no ratio to quote.
- ¥11,684,403/LY (approximately 114,652 USD/LY) per LYDSA: total cost of TACE minimized
- ¥4,566,179/LY (approximately 44,774 USD/LY) per LYDSA: total cost of CIRT maximized
- ¥177,259/LY (approximately 1738 USD/LY) per LYadditional analysis: all CIRT technical fees set at ¥3,140,000
- ¥12,062,688/LY (approximately 118,262 USD/LY) per LYadditional analysis DSA: total cost of CIRT maximized
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
- 34 patients with HCC treated with CIRT or TACE at Gunma University, 2007-2016, selected by propensity score matching; localized HCC unsuitable for surgery or RFA
- Comparator
- Transarterial chemoembolization (TACE)
- Indication
- Hepatocellular carcinoma (localized HCC ineligible for surgery or radiofrequency ablation)
- Study design
- Cost-effectiveness analysis using propensity-score-matched patient cohort from Gunma University (retrospective); outcome measure life years; sensitivity analysis; acceptability rate reported
- Time horizon
- 1 month before treatment initiation to 3 years thereafter
- Delivery technique
- not reported by this study
- Perspective
- Public health care payers
- Currency
- JPY
- Price year
- not reported by this study
- Willingness-to-pay threshold
- ¥4,000,000/LY (approximately 39,216 USD/LY), adopted by the authors as the WTP threshold; CIRT acceptability >70% at this level in the PSA
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- CIRT technical fee ¥3,140,000 (a second CIRT treatment on the same organ within 2 years was performed for free)
- Cost of the comparator assumed
- ¥5,284,524 (approximately 51,809 USD), mean total cost in the TACE group
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
83 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.