Analysis of the cost-effectiveness of proton beam therapy for unresectable pancreatic cancer
PD-0083
Abstract
Analysis of the cost-effectiveness of proton beam therapy for unresectable pancreatic cancer
Authors: Yuichi Hiroshima1, Masahide Kondo2, Takuya Sawada3, Shu-ling Hoshi2, Reiko Okubo2, Takashi Iizumi3, Haruko Numajiri3, Toshiyuki Okumura3, Hideyuki Sakurai3
1University of Tsukuba, Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, Tsukuba, Japan; 2University of Tsukuba, Department of Health Care Policy and Health Economics, Faculty of Medicine, Tsukuba, Japan; 3University of Tsukuba, Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, Tsukuba, Japan
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Purpose or Objective
Pancreatic cancer is one of the most common malignant tumors and has a poor prognosis. Recently, an increasing number of reports have used proton beam therapy (PBT) to treat unresectable, locally advanced pancreatic cancer (LAPC). However, the cost-effectiveness of PBT for pancreatic cancer has not been evaluated. This study aimed to determine the cost-effectiveness of PBT for LAPC as a replacement for conventional photon radiotherapy (RT).
Material and Methods
We estimated the incremental cost-effectiveness ratio (ICER) of PBT as a replacement for three-dimensional conformal radiotherapy (3DCRT), a conventional photon RT, using clinical evidence in the literature and expense complemented by expert opinions. We used a decision tree and an economic and Markov model to illustrate the disease courses followed by LAPC patients. In the decision tree model, we assumed that some patients underwent chemotherapy after receiving PBT or 3DCRT. Effectiveness was estimated as quality-adjusted life years (QALY) using utility weights for the health state. The Markov cycle for each stage was set at one month, with the model programmed to cease when the cohort’s stage reached the 60th month. Social insurance fees were calculated as the costs. The stability of the ICER against the assumptions made was appraised using sensitivity analyses.
Results
The effectiveness of PBT and 3DCRT was 1.67610615 and 0.97181271 QALY, respectively. The ICER was estimated to be ¥5,376,915 (US$46,756) per QALY. According to the suggested threshold for anti-cancer therapy from the Japanese authority of ¥7,500,000 (US$65,217) per QALY gain, such a replacement would be considered cost-effective. The one-way and probabilistic sensitivity analyses demonstrated stability of the base-case ICER.
Conclusion
PBT, as a replacement for conventional photon radiotherapy, is cost-effective and justifiable as an efficient use of finite healthcare resources. Making it a standard treatment option and available to every patient in Japan is socially acceptable from the perspective of health economics.