Yoshimura et al 2025
Journal of radiation research · 2025 · Japan · Proton
This cost-utility study modelled proton beam therapy (PBT) against conventional photon therapy for a hypothetical cohort of children aged 8 with medulloblastoma treated in Japan, with a 36:64 split between standard- and high-risk patients. It took a public healthcare payer perspective over a lifetime horizon, using a Markov model with health states for secondary cancer, hypothyroidism and hearing loss. The authors concluded that PBT was cost-effective.
What it compared
The study compared proton beam therapy with conventional photon therapy in a hypothetical cohort of standard- and high-risk paediatric medulloblastoma patients treated in Japan.
What it found
The base-case ICER was JPY 887053 per QALY, judged against a threshold of JPY 5 million per QALY, with PBT yielding an additional 1.56 QALYs and an additional JPY 1387116 in costs. Deterministic sensitivity analysis gave a range of JPY 284782 to JPY 1918603 per QALY, and probabilistic sensitivity analysis gave a 91.7% probability that PBT was cost-effective.
What to keep in mind
The price year for the costs is not stated, the costs and transition probabilities come from a modelled cohort rather than observed patients, and the utilities and transition probabilities are drawn from published literature. The study gives a quality score of 80.
The figures it reported
- JPY 887053 per QALYPBT vs photon therapy (base case)
- JPY 284782 per QALYDeterministic sensitivity analysis lower bound
- JPY 1918603 per QALYDeterministic sensitivity analysis upper bound
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 cohort of standard- and high-risk pediatric medulloblastoma patients aged 8 years treated in Japan (standard:high-risk proportion 36:64); time horizon lifetime; public healthcare payer perspective
- Comparator
- Conventional photon therapy
- Indication
- Pediatric medulloblastoma
- Study design
- Cost-utility analysis; Markov model; outcome QALYs; health states secondary cancer, hypothyroidism and hearing loss
- Time horizon
- Lifetime
- Delivery technique
- not reported by this study
- Perspective
- Public healthcare payer
- Currency
- JPY
- Price year
- not reported by this study
- Willingness-to-pay threshold
- JPY 5 million/QALY
- Discount rate
- 2.0% per year for both costs and outcomes
- Cost of the particle course assumed
- JPY 2,375,000 per patient (PBT cost, same for both risk groups)
- Cost of the comparator assumed
- Conventional photon therapy: JPY 683,220 (standard-risk) and JPY 726,900 (high-risk)
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
80 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.