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Cost-Effectiveness of Proton Versus Photon Therapy for Medulloblastoma Using Updated Clinical Outcomes
Chonnipa Nantavithya1,2, Anussara Prayongrat1,2, Wasin Laohavinij3
1Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Proton beam therapy (PBT) is more cost-effective than traditional X-ray therapy (XRT) for pediatric medulloblastoma in middle-income countries. This analysis highlights PBT’s long-term benefits, especially considering cognitive function, despite initial higher costs.
Area of Science:
- Oncology
- Radiation Therapy
- Health Economics
Background:
- Pediatric cancer survivors face significant long-term costs and side effects from radiation therapy.
- Proton beam therapy (PBT) offers potential benefits in reducing these long-term issues but presents higher upfront costs.
- Implementing advanced treatments like PBT in middle-income countries requires thorough cost-effectiveness analysis.
Purpose of the Study:
- To evaluate the cost-effectiveness of PBT compared to conventional photon beam therapy (XRT) for pediatric medulloblastoma.
- To incorporate updated clinical outcomes and long-term side effect data into the economic model.
- To assess the feasibility of PBT within the economic context of a middle-income country.
Main Methods:
- Markov and Monte Carlo simulation models were employed for analysis.
- Data on mortality rates, treatment side effects (hormone deficiencies, hearing loss, secondary brain tumors, thyroid cancer, IQ decline), and associated utilities were compiled from literature and adjusted for a middle-income country context (Thailand).
- Economic parameters, including medical and non-medical costs, were analyzed over the patient's lifetime.
Main Results:
- The base-case analysis indicated PBT had lower total costs ($69,349 USD) and higher utilities (36.12) compared to XRT ($80,217 USD, 35.23 utilities).
- The incremental cost-effectiveness ratio (ICER) favored PBT, with a negative value (-$12,211 USD/QALY).
- Sensitivity analyses confirmed PBT's cost-effectiveness, though XRT appeared more cost-effective if the opportunity cost of IQ decline was excluded.
Conclusions:
- Proton beam therapy is a more cost-effective treatment option than XRT for pediatric medulloblastoma in middle-income countries, considering updated clinical data.
- The long-term benefits of PBT, particularly in mitigating cognitive decline (IQ loss), significantly contribute to its favorable economic profile.
- The findings support the adoption of PBT in resource-constrained settings when long-term patient outcomes are prioritized.
Purpose:
The benefit of proton beam therapy (PBT) is evident in pediatric cancer, as survivors have to face long-term radiation-related side effects and lifetime costs. However, PBT's higher costs cause a challenge especially in middle-income countries. This study analyzed cost-effectiveness of PBT versus photon beam therapy (XRT) for medulloblastoma based on updated clinical outcomes within middle-income country context.
Materials And Methods:
Markov and Monte Carlo models were constructed for simulation analysis. We used annual mortality rates based on actual medulloblastoma patients receiving craniospinal irradiation over the first 5 years, combined with general population mortality rates thereafter. Rates and utilities for side effects, including hormone deficiencies, hearing loss, brain tumors, thyroid cancer, and IQ decline, were derived from previous literature, while the cardiac mortality rate was estimated using a linear model. Medical and nonmedical costs, along with other economic parameters and mortality rates during the first 5 years, were derived within the context of a middle-income country, using Thailand as a representative setting where PBT is operational.
Results:
For the base-case model, the total costs for PBT and XRT were 69 349 USD (2 357 874 THB) and 80 217 USD (2 727 366 THB), respectively, with total utilities of 36.12 and 35.23, respectively. The ICER was -12 211 USD (-415 160 THB)/QALY, and the net monetary benefit for PBT and XRT were 100 627 USD (3 421 326 THB) and 85 572 USD (2 909 434 THB), respectively. Including microsimulation and probabilistic sensitivity analysis for side effects rates, mortality rates, inflation, cost reduction, and utility reduction, PBT was still cost-effective. However, XRT was found to be more cost-effective when excluding opportunity loss from IQ decline.
Conclusion:
Despite its higher cost, PBT was more cost-effective than XRT for treating medulloblastoma in a middle-income country, based on updated clinical outcomes, particularly when incorporating IQ decline into the analysis.
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