Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
PLoS One. 2024 Sep 27;19(9):e0308961. doi: 10.1371/journal.pone.0308961. eCollection 2024.
Proton beam therapy (PBT) has recently been included in Japan's health insurance benefit package for certain cancer types. This study aimed to determine the cost-effectiveness of PBT as a replacement for conventional three-dimensional conformal radiotherapy (3D-CRT) for locally advanced esophageal cancer (LAEC) that is not covered by social insurance.
We estimated the incremental cost-effectiveness ratio (ICER) of PBT as a replacement for 3D-CRT, using clinical evidence from the literature and expert opinions. We used an economic model, decision tree, and Markov model to illustrate the courses followed by patients with LAEC. Effectiveness was estimated as quality-adjusted life years (QALY) using utility weights for the health state. Social insurance fees were calculated as costs. We assumed two base cases depending on the two existing levels of fees for PBT in social insurance: 2,735,000 Japanese yen (US$20,652) or 1,600,000 yen (US$13,913). The stability of the ICER against these assumptions was appraised using sensitivity analysis.
The effectiveness of PBT and 3D-CRT was 2.62 and 2.51 QALY, respectively. The estimated ICER was 14,025,268 yen (US$121,958) per QALY for the higher fee level and 7,026,402 yen (US$61,099) for the lower fee level. According to the Japanese threshold for cost-effectiveness of anticancer therapy of 7,500,000 yen (US$65,217) per QALY gain, the inclusion of PBT for LAEC in the benefit package of social insurance is cost-effective if a lower fee is applied.
PBT is a cost-effective alternative to 3D-CRT for LAEC and making it available to patients under social insurance could be justifiable.
质子束疗法（PBT）最近已被纳入日本某些癌症类型的医疗保险福利范围。本研究旨在确定 PBT 作为未纳入社会保险的局部晚期食管癌（LAEC）替代常规三维适形放疗（3D-CRT）的成本效益。
我们使用文献中的临床证据和专家意见来估算 PBT 替代 3D-CRT 的增量成本效益比（ICER）。我们使用经济模型、决策树和马尔可夫模型来说明 LAEC 患者的治疗过程。使用健康状态的效用权重来估计疗效作为质量调整生命年（QALY）。社会保险费用被计算为成本。我们假设了两种基本情况，取决于社会保险中 PBT 的两种现有费用水平：2735000 日元（20652 美元）或 1600000 日元（13913 美元）。使用敏感性分析评估 ICER 对这些假设的稳定性。
PBT 和 3D-CRT 的疗效分别为 2.62 和 2.51 QALY。对于较高费用水平，估计的 ICER 为 14025268 日元（121958 美元）/QALY，对于较低费用水平，为 7026402 日元（61099 美元）/QALY。根据日本抗癌治疗成本效益的 7500000 日元（65217 美元）/QALY 的获益阈值，如果适用较低的费用，将 PBT 纳入社会保险的福利范围对于 LAEC 是具有成本效益的。
PBT 是 LAEC 的 3D-CRT 的一种具有成本效益的替代方法，如果将其纳入社会保险范围内，为患者提供 PBT 可能是合理的。
