Guo Li1,2, Yun-Fei Xia3,4, Yi-Xiang Huang5, Deniz Okat6, Bo Qiu3,4, Jerome Doyen7,8, Pierre-Yves Bondiau7,8, Karen Benezery7,8, Jin Gao9, Chao-Nan Qian1,3. 1. Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, China. 2. Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China. 3. State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China. 4. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. 5. Department of Health Management, Public Health Institute of Sun Yat-sen University, Guangzhou, China. 6. Department of Finance, Hong Kong University of Science and Technology, Hong Kong, China. 7. Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France. 8. Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France. 9. Division of Life Sciences and Medicine, Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
Abstract
BACKGROUND: Compared to conventional intensity-modulated photon radiation therapy (IMRT), intensity-modulated proton radiation therapy (IMPT) has potential to reduce irradiation-induced late toxicities while maintaining excellent tumor control in patients with nasopharyngeal carcinoma (NPC). However, the relevant cost-effectiveness remains controversial. METHODS: A Markov decision tree analysis was performed under the assumption that IMPT offered normal tissue complication probability reduction (NTCP reduction) in long-term dysphagia, xerostomia, and hearing loss, compared to IMRT. Base-case evaluation was performed on T2N2M0 NPC of median age (43 years old). A Chinese societal willingness-to-pay threshold (33558 US dollars [$])/quality-adjusted life-year [QALY]) was adopted. RESULTS: For patients at median age and having NTCP reduction of 10%, 20%, 30%, 40%, 50%, and 60%, their incremental cost-effectiveness ratios were $102684.0/QALY, $43161.2/QALY, $24134.7/QALY, $13991.6/QALY, $8259.8/QALY, and $4436.1/QALY, respectively; IMPT should provide an NTCP reduction of ≥24% to be considered cost-effective. CONCLUSIONS: IMPT has potential to be cost-effective for average Chinese NPC patients and should be validated clinically.
BACKGROUND: Compared to conventional intensity-modulated photon radiation therapy (IMRT), intensity-modulated proton radiation therapy (IMPT) has potential to reduce irradiation-induced late toxicities while maintaining excellent tumor control in patients with nasopharyngeal carcinoma (NPC). However, the relevant cost-effectiveness remains controversial. METHODS: A Markov decision tree analysis was performed under the assumption that IMPT offered normal tissue complication probability reduction (NTCP reduction) in long-term dysphagia, xerostomia, and hearing loss, compared to IMRT. Base-case evaluation was performed on T2N2M0 NPC of median age (43 years old). A Chinese societal willingness-to-pay threshold (33558 US dollars [$])/quality-adjusted life-year [QALY]) was adopted. RESULTS: For patients at median age and having NTCP reduction of 10%, 20%, 30%, 40%, 50%, and 60%, their incremental cost-effectiveness ratios were $102684.0/QALY, $43161.2/QALY, $24134.7/QALY, $13991.6/QALY, $8259.8/QALY, and $4436.1/QALY, respectively; IMPT should provide an NTCP reduction of ≥24% to be considered cost-effective. CONCLUSIONS: IMPT has potential to be cost-effective for average Chinese NPC patients and should be validated clinically.
Authors: Wai Tong Ng; Barton But; Charlene H L Wong; Cheuk-Wai Choi; Melvin L K Chua; Pierre Blanchard; Anne W M Lee Journal: Clin Transl Radiat Oncol Date: 2022-08-23