Sawada et al 2024
PloS one · 2024 · Japan · Proton
This cost-utility study from Japan modelled whether proton beam therapy (PBT) is cost-effective compared with conventional three-dimensional conformal radiotherapy (3D-CRT) for locally advanced oesophageal cancer that is not covered by social insurance. It used a decision tree and a Markov model, with clinical inputs taken from the literature and expert opinion, and took the payer's perspective with a 60-month horizon and 3% annual discounting. The authors report that PBT is cost-effective only at the lower of two social insurance fee levels, and that the inclusion of PBT in the benefit package could be justifiable under that condition.
What it compared
The study compared PBT with 3D-CRT as a replacement treatment in a hypothetical cohort of patients with locally advanced oesophageal cancer not covered by social insurance.
What it found
The ICER was 14,025,268 yen (US$121,958) per QALY at the higher PBT fee level (2,375,000 yen) and 7,026,402 yen (US$61,099) per QALY at the lower fee level (1,600,000 yen), judged against a threshold of 7,500,000 yen (US$65,217) per QALY gain.
What to keep in mind
The model is built on hypothetical patients with inputs from the literature and expert opinion rather than trial-based patient data, the price year for costs is not stated, and the time horizon is only 60 months, so the result depends heavily on the assumed fee level and clinical inputs.
The figures it reported
- 14,025,268 yen (US$121,958) per QALYhigher PBT fee level (2,375,000 yen)
- 7,026,402 yen (US$61,099) per QALYlower PBT fee level (1,600,000 yen)
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Hypothetical patients with locally advanced esophageal cancer not covered by social insurance
- Comparator
- three-dimensional conformal radiotherapy (3D-CRT)
- Indication
- locally advanced esophageal cancer (LAEC)
- Study design
- Cost-utility analysis; decision tree plus Markov model; outcome QALY (utility weights for health states), using clinical evidence from literature and expert opinion
- Time horizon
- 60 months (Markov model programmed to cease when the cohort reached the 60th month; 3-month cycles)
- Delivery technique
- not reported by this study
- Perspective
- Payer's perspective (Japan social insurance system; medical costs paid directly by the social insurer and patient)
- Currency
- JPY (US$ conversions given in abstract)
- Price year
- not reported by this study
- Willingness-to-pay threshold
- 7,500,000 yen (US$65,217) per QALY gain (Japanese threshold for anticancer therapy)
- Discount rate
- 3% annual rate applied to costs and outcomes
- Cost of the particle course assumed
- 1,600,000 yen (US$13,913) or 2,375,000 yen (US$20,652) per PBT course (the two social insurance fee levels)
- Cost of the comparator assumed
- 727,600 yen (US$6,313) for 3D-CRT
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
Cost-effective only if the lower social insurance fee level (1,600,000 yen, US$13,913) is applied; not cost-effective at the higher fee level (2,375,000 yen, US$20,652), per the ICER values reported.
Reporting quality
84 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.