Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong, 510095, P. R. China.
State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.
BMC Cancer. 2020 Jun 26;20(1):599. doi: 10.1186/s12885-020-07083-x.
Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT, the advanced form of proton beam therapy) has been found to improve the prognosis of the patients with paranasal sinus and nasal cavity cancers compared with intensity-modulated photon-radiation therapy (IMRT). However, the cost-effectiveness of IMPT has not yet been fully evaluated. This study aimed at evaluating the cost-effectiveness of IMPT versus IMRT for treatment decision making of paranasal sinus and nasal cavity cancers in Chinese settings.
A 3-state Markov model was designed for cost-effectiveness analysis. A base case evaluation was performed on a patient of 47-year-old (median age of patients with paranasal sinus and nasal cavity cancers in China). Model robustness was examined by probabilistic sensitivity analysis, Markov cohort analysis and Tornado diagram. Cost-effective scenarios of IMPT were further identified by one-way sensitivity analyses and stratified analyses were performed for different age levels. The outcome measure of the model was the incremental cost-effectiveness ratio (ICER). A strategy was defined as cost-effective if the ICER was below the societal willingness-to-pay (WTP) threshold of China (30,828 US dollars ($) / quality-adjusted life year (QALY)).
IMPT was identified as being cost-effective for the base case at the WTP of China, providing an extra 1.65 QALYs at an additional cost of $38,928.7 compared with IMRT, and had an ICER of $23,611.2 / QALY. Of note, cost-effective scenarios of IMPT only existed in the following independent conditions: probability of IMPT eradicating cancer ≥0.867; probability of IMRT eradicating cancer ≤0.764; or cost of IMPT ≤ $52,163.9. Stratified analyses for different age levels demonstrated that IMPT was more cost-effective in younger patients than older patients, and was cost-effective only in patients ≤56-year-old.
Despite initially regarded as bearing high treatment cost, IMPT could still be cost-effective for patients with paranasal sinus and nasal cavity cancers in China. The tumor control superiority of IMPT over IMRT and the patient's age should be the principal considerations for clinical decision of prescribing this new irradiation technique.
在发展中国家，成本效益是高科技癌症治疗临床决策的关键考虑因素。调强质子放射治疗（IMPT，质子束治疗的高级形式）已被发现可改善鼻窦和鼻腔癌症患者的预后，优于调强光子放射治疗（IMRT）。然而，IMPT 的成本效益尚未得到充分评估。本研究旨在评估在中国鼻窦和鼻腔癌治疗决策中，IMPT 与 IMRT 的成本效益。
设计了一个三状态马尔可夫模型进行成本效益分析。对一名 47 岁患者（中国鼻窦和鼻腔癌患者的中位年龄）进行了基准案例评估。通过概率敏感性分析、马尔可夫队列分析和龙卷风图对模型的稳健性进行了检验。通过单向敏感性分析进一步确定了 IMPT 的成本效益情景，并对不同年龄水平进行了分层分析。模型的结果衡量指标是增量成本效益比（ICER）。如果 ICER 低于中国（30,828 美元（$）/质量调整生命年（QALY））的社会意愿支付（WTP）阈值，则将一种策略定义为具有成本效益。
在 WTP 为中国的情况下，IMPT 被确定为具有成本效益，与 IMRT 相比，提供了额外的 1.65 个 QALY，额外成本为 38,928.7 美元，ICER 为 23,611.2 / QALY。值得注意的是，IMPT 的成本效益情景仅存在于以下独立条件下：IMPT 消除癌症的概率≥0.867；IMRT 消除癌症的概率≤0.764；或 IMPT 的成本≤52,163.9 美元。不同年龄水平的分层分析表明，IMPT 在年轻患者中比老年患者更具成本效益，并且仅在≤56 岁的患者中具有成本效益。
尽管 IMPT 的初始治疗费用较高，但在中国，鼻窦和鼻腔癌患者仍可能具有成本效益。IMPT 相对于 IMRT 的肿瘤控制优势以及患者的年龄应是临床决策中采用这种新放疗技术的主要考虑因素。
