Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):875-882. doi: 10.1016/j.ijrobp.2018.04.018. Epub 2018 Apr 12.
To compared the cost-effectiveness of intensity modulated proton beam therapy (PBT) and intensity modulated radiation therapy (IMRT) in the management of stage III-IVB oropharynx cancer (OPC).
A Markov model was constructed to compare IMRT with PBT for a 65-year-old patient with stage IVA OPSCC. We assumed PBT led to a 25% reduction in long-term xerostomia, short-term dysgeusia, and the need for gastrostomy tube. Fewer dental complications were also expected with PBT. Incremental cost-effectiveness ratios (ICERs) were calculated, and value of information analyses were performed. The societal willingness-to-pay was defined as $100K per quality-adjusted life year (QALY).
The ICERs for PBT for favorable human papillomavirus (HPV)-positive OPC were $288,000/QALY and $390,000/QALY in the payer perspective (PP) and societal perspective, respectively. Under nearly every scenario, PBT was not cost-effective, with ICERs above $150,000/QALY in the PP. The ICERs for HPV-negative OPC were typically greater than $250K/QALY in both perspectives. For HPV-positive patients, the ICER was less than $100,000/QALY in the PP only in younger patients who experienced a 50% reduction in both xerostomia and gastrostomy use. On probabilistic sensitivity analyses, there were 0% and 0.4% probabilities that PBT was cost-effective for 65- and 55-year old patients, respectively. The value of information was zero or negligible for all ages and perspectives at willingness-to-pay of $100,000/QALY and only meaningful in the PP for younger patients at a willingness-to-pay of $150,000/QALY.
Intensity modulated proton beam therapy was only cost-effective in the PP if assumed to achieve profound reductions in long-term morbidity for younger patients; it was never cost-effective in the societal perspective. Prospective data are needed (and may be valuable) to better characterize the comparative toxicities of these treatments but are unlikely to change this calculation, except potentially in the most favorable cohort of patients.
比较调强质子束治疗（PBT）和调强放射治疗（IMRT）在治疗 III-IVB 期口咽癌（OPC）中的成本效益。
我们构建了一个 Markov 模型，以比较 65 岁 IVA 期 OPSCC 患者的 IMRT 和 PBT。我们假设 PBT 可将长期口干、短期味觉障碍和胃造口管需求降低 25%。此外，PBT 还可减少牙科并发症。我们计算了增量成本效益比（ICER），并进行了价值信息分析。社会意愿支付定义为每质量调整生命年（QALY）$100K。
对于有利的人乳头瘤病毒（HPV）阳性 OPC，PBT 的 ICER 在支付者视角（PP）和社会视角下分别为$288,000/QALY 和$390,000/QALY。在几乎所有情况下，PBT 都不具有成本效益，在 PP 中，ICER 均高于$150,000/QALY。HPV 阴性 OPC 的 ICER 在两个视角下通常均大于$250K/QALY。对于 HPV 阳性患者，仅在经历口干和胃造口管使用减少 50%的年轻患者中，PP 中的 ICER 低于$100,000/QALY。在概率敏感性分析中，对于 65 岁和 55 岁的患者，PBT 具有成本效益的概率分别为 0%和 0.4%。在支付意愿为$100,000/QALY 时，所有年龄段和视角的信息价值均为零或微不足道，仅在支付意愿为$150,000/QALY 时，对年轻患者才有意义。
仅当假设 PBT 能为年轻患者带来长期发病率的显著降低时，PBT 在 PP 中才具有成本效益；而在社会视角下，PBT 从不具有成本效益。需要（且可能有价值）前瞻性数据来更好地描述这些治疗方法的相对毒性，但除非在最有利的患者队列中，否则不太可能改变这一计算结果。
