Yoshimura Takaaki, Tamori Honoka, Morii Yasuhiro, Hashimoto Takayuki, Shimizu Shinichi, Ogasawara Katsuhiko
Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan.
Department of Medical Physics, Hokkaido University Hospital, Sapporo 060-0812, Japan.
J Radiat Res. 2021 Sep 29. doi: 10.1093/jrr/rrab077.
Compared to conventional X-ray therapy, proton beam therapy (PBT) has more clinical and physical advantages such as irradiation dose reduction to normal tissues for pediatric medulloblastoma. However, PBT is expensive. We aimed to compare the cost-effectiveness of PBT for pediatric medulloblastoma with that of conventional X-ray therapy, while focusing on radiation-induced secondary cancers, which are rare, serious and negatively affect a patient's quality of life (QOL). Based on a systematic review, a decision tree model was used for the cost-effectiveness analysis. This analysis was performed from the perspective of health care payers; the cost was estimated from medical fees. The target population was pediatric patients with medulloblastoma below 14 years old. The time horizon was set at 7.7 years after medulloblastoma treatment. The primary outcome was the incremental cost-effectiveness ratio (ICER), which was defined as the ratio of the difference in cost and lifetime attributable risk (LAR) between conventional X-ray therapy and PBT. The discount rate was set at 2% annually. Sensitivity analyses were performed to model uncertainty. Cost and LAR in conventional X-ray therapy and PBT were Japanese yen (JPY) 1 067 608 and JPY 2436061 and 42% and 7%, respectively. The ICER was JPY 3856398/LAR. In conclusion, PBT is more cost-effective than conventional X-ray therapy in reducing the risk of radiation-induced secondary cancers in pediatric medulloblastoma. Thus, our constructed ICER using LAR is one of the valid indicators for cost-effectiveness analysis in radiation-induced secondary cancer.
与传统的X射线疗法相比，质子束疗法（PBT）具有更多临床和物理优势，例如在小儿髓母细胞瘤治疗中可减少对正常组织的照射剂量。然而，PBT成本高昂。我们旨在比较PBT与传统X射线疗法治疗小儿髓母细胞瘤的成本效益，同时关注辐射诱发的继发性癌症，此类癌症罕见、严重且会对患者生活质量（QOL）产生负面影响。基于系统评价，使用决策树模型进行成本效益分析。该分析从医疗保健支付方的角度进行；成本根据医疗费用估算。目标人群为14岁以下的小儿髓母细胞瘤患者。时间范围设定为髓母细胞瘤治疗后的7.7年。主要结局为增量成本效益比（ICER），其定义为传统X射线疗法与PBT之间成本差异与终生归因风险（LAR）之比。贴现率设定为每年2%。进行敏感性分析以模拟不确定性。传统X射线疗法和PBT的成本及LAR分别为1 067 608日元和2 436 061日元，以及42%和7%。ICER为3 856 398日元/LAR。总之，在降低小儿髓母细胞瘤辐射诱发继发性癌症风险方面，PBT比传统X射线疗法更具成本效益。因此，我们使用LAR构建的ICER是辐射诱发继发性癌症成本效益分析的有效指标之一。
