Optimizing oropharyngeal cancer management by using proton beam therapy: trends of cost-effectiveness

Li, Guo; Xia, Yun-Fei; Huang, Yi-Xiang; Okat, Deniz; Qiu, Bo; Doyen, Jerome; Bondiau, Pierre-Yves; Benezery, Karen; Gao, Jin; Qian, Chao-Nan

doi:10.1186/s12885-021-08638-2

BMC Cancer

Table 1 Model information and probabilistic sensitivity analysis for the analyzed parameters

From: Optimizing oropharyngeal cancer management by using proton beam therapy: trends of cost-effectiveness

Parameters	Input Information	90% CI in PSA^a	Distribution^b	Source
Target cancer	OPC
Evaluated treatment strategies	IMPT vs. IMRT
Base-case set-ups
Patient age^c	56-year-old^d
Disease probabilities
DFS (1-year)	0.85			De Felice et al. [25]
OS (1-year)	0.9			De Felice et al. [25]
“no cancer” to “alive with cancer”	0.03(2nd-5rd year); 0 (6th -10th year)			De Felice et al. [25]
“alive with cancer” to “cancer death”	0.3			De Felice et al. [25]
Long-term toxicities probabilities
NTCP of dysphagia after IMRT	0.19	0.129–0.256	Beta	Bird et al. [5]
NTCP of xerostomia after IMRT	0.33	0.266–0.394	Beta	Al-Mamgani et al. [6]
NTCP of dysphagia after IMPT	0.143	0.082–0.209	Beta	Meijer et al. [12]
NTCP of xerostomia after IMPT	0.248	0.185–0.312	Beta	Meijer et al. [12]
Utilities (QALY)
No complication	1
Dysphagia	0.803	0.671–0.918	Beta	Ramaekers et al. [9]
Xerostomia	0.846	0.714–0.955	Beta	Ramaekers et al. [9]
Dysphagia and xerostomia	0.763	0.631–0.881	Beta	Ramaekers et al. [9]
Alive with cancer	0.57	0.442–0.696	Beta	de Almeida et al. [26]
Death (cancer death or other death)	0
Cost ($)
IMPT	50,000	37,134.7 - 62,882.3	Normal	SPHIC
IMRT	12,000	10,737.4 - 13,282.5	Normal	SYSUCC
Concurrent chemotherapy	5000	3728.8 - 6297.3	Normal	SYSUCC
Follow-up / year	1000	869.7–1128.0	Normal	SYSUCC
Treatment for dysphagia / year	3000	1716.6 - 4273.0	Normal	SYSUCC
Treatment for xerostomia / year	2000	1362.6 - 2641.6	Normal	SYSUCC
Palliative therapy / year	5000	2411.2 - 7567.2	Normal	SYSUCC
Markov model set-up
Cycle length	1-year
Number of cycles	77^e - patient age
Discount rate / year	3%

CI confidence interval, PSA probabilistic sensitivity analysis, OPC oropharyngeal cancer, IMPT intensity-modulated proton radiation therapy, IMRT intensity-modulated radiation therapy, OS overall survival, DFS disease-free survival, NTCP normal tissue complication probability, QALY quality-adjusted life-year, $ US dollars, SPHIC Shanghai Proton and Heavy Ion Center, SYSUCC Sun Yat-sen University Cancer Center, CEA cost-effectiveness analysis
^aProbabilistic sensitivity analysis (PSA) was performed to determine 90% CI for model parameters by running over 50,000 iteration trials
^bThe utilities and probabilities were tested using beta distribution and the costs were tested using uniform distribution
^cThe patient age when preparing for radiotherapy
^dMedian age of OPC patients in China
^eThe estimated Chinese life expectancy. For the base case, Markov models were to be cycled 21 times to evaluate the outcomes over a time-period from 1 year after radiotherapy to the end of the estimated Chinese life expectancy

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ISSN: 1471-2407

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