Sampaio et al 2024
Cost effectiveness and resource allocation : C/E · 2024 · Sweden · Proton
This study assessed whether proton beam therapy (PBT) is cost-effective compared with conventional radiotherapy (CRT) for adult patients with brain tumours treated in Sweden. It used data from a non-randomised prospective multicentre longitudinal study run between 2015 and 2020, linked to national registers for healthcare resource use, with propensity score matching of 310 PBT patients to 40 CRT patients. Costs were taken from a healthcare perspective over a 58-week horizon, and health outcomes were measured as QALYs derived from the EORTC-QLQ-C30. The authors concluded that PBT cannot be considered cost-effective compared with CRT for brain tumours.
What it compared
Proton beam therapy compared with conventional radiotherapy in adult patients with brain tumours treated in Sweden, from a healthcare perspective.
What it found
PBT had higher total costs than CRT, 14,639 US$ versus 13,308 US$, a difference of 1,372 US$ (95% CI, -4,914 to 7,659) over 58 weeks. PBT produced non-significantly fewer QALYs, 0.746 versus 0.774, a difference of -0.049 (95% CI, -0.195 to 0.097). The probability of PBT being cost-effective was below 30% at any willingness-to-pay threshold; no willingness-to-pay threshold or ICER is stated in the paper.
What to keep in mind
Costs are in 2023 US$ (PPP) converted from 2021 Swedish Krona, the particle and comparator costs are not separately reported, the time horizon is only 58 weeks, the CRT comparison group is small (n = 40) and the QALYs rely on a quality-of-life questionnaire rather than a brain-tumour-specific measure, so the long-term picture is not captured.
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
- Adult patients with brain tumors treated 2015-2020 in a Swedish non-randomized prospective multicenter study; PBT group n = 310 matched to CRT group n = 40 by propensity score matching with replacement
- Comparator
- Conventional radiotherapy (CRT)
- Indication
- Brain tumors (adult patients; specific histologies not specified in abstract)
- Study design
- Cost-utility analysis using propensity score matching with replacement on data from a non-randomized prospective longitudinal study; generalized linear models and two-part models for costs and QALYs; QALYs derived from EORTC-QLQ-C30
- Time horizon
- 58 weeks
- Delivery technique
- not reported by this study
- Perspective
- Healthcare perspective
- Currency
- US$
- Price year
- 2021 Swedish Krona (SEK) prices, converted to 2023 US$ (PPP)
- Willingness-to-pay threshold
- not reported by this study
- Discount rate
- not reported by this study
- 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.
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.