Optimizing oropharyngeal cancer management by using proton beam therapy: trends of cost-effectiveness.
Optimizing oropharyngeal cancer management by using proton beam therapy: trends of cost-effectiveness.
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使用质子束治疗优化口咽癌治疗：成本效益趋势
DOI：
10.1186/s12885-021-08638-2
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发表时间：
2021-08-21
期刊：
影响因子：
3.8
通讯作者：
Qian CN
中科院分区：
文献类型：
--
作者：
Li G;Xia YF;Huang YX;Okat D;Qiu B;Doyen J;Bondiau PY;Benezery K;Gao J;Qian CN
背景质子束治疗（PBT）是一种新兴的肿瘤治疗方法，但其治疗费用较高，目前尚未纳入中国的公共医疗保险。PBT的高级形式，调强质子放射治疗（IMPT），已被证实，以减少正常组织并发症的概率（NTCP）相比，传统的调强光子放射治疗（IMRT）的患者口咽癌（OPC）。在此，我们评估IMPT与IMRT在中国OPC患者中的成本效果和适用性，旨在指导PBT的正确使用。方法设计一个7状态马尔可夫模型进行分析。假设IMPT可使长期症状性吞咽困难和口干症的NTCP减少25%，对56岁（中国OPC的中位年龄）患者进行基础病例评价。使用概率敏感性分析、队列分析和龙卷风图检查模型稳健性。进行了单向敏感性分析，以确定具有成本效益的情景。如果增量成本效益比（ICER）低于社会支付意愿（WTP）阈值，则IMPT被认为具有成本效益。结果IMPT较IMRT多提供了0.205质量调整生命年（QALY），增加成本34，926.6美元（），基础病例ICER为170，082.4/QALY。在中国目前的支付意愿（33，558/QALY）和IMPT治疗费用为50，000的情况下，IMPT应分别提供47.5%、50.8%、55.6%、63.3%和77.2%的NTCP降低，才能被认为对10、20、30、40和50岁的患者具有成本效益。对于中位年龄水平的患者，将当前IMPT成本（50，000）降低至30，000水平将使中国当前WTP下的“成本-效果”最低NTCP降低阈值从91.4%降至44.6%（WTP为50，000/QALY时从69.0%降至33.5%; WTP为100，000/QALY时从39.7%降至19.1%）。结论在中国目前的支付意愿下，中国OPC患者存在PBT的成本-效果方案。考虑到PBT在中国的潜在使用即将增加，如果质子处理成本下降或WTP水平增加，这种成本效益情景可能会进一步扩大。
Background Proton beam therapy (PBT) is a new-emerging cancer treatment in China but its treatment costs are high and not yet covered by Chinese public medical insurance. The advanced form of PBT, intensity-modulated proton radiation therapy (IMPT), has been confirmed to reduce normal tissue complication probability (NTCP) as compared to conventional intensity-modulated photon-radiation therapy (IMRT) in patients with oropharyngeal cancer (OPC). Herein, we evaluated the cost-effectiveness and applicability of IMPT versus IMRT for OPC patients in China, aiming at guiding the proper use of PBT. Methods A 7-state Markov model was designed for analysis. Base-case evaluation was performed on a 56-year-old (median age of OPC in China) patient under the assumption that IMPT could provide a 25% NTCP-reduction in long-term symptomatic dysphagia and xerostomia. Model robustness was examined using probabilistic sensitivity analysis, cohort analysis, and tornado diagram. One-way sensitivity analyses were conducted to identify the cost-effective scenarios. IMPT was considered as cost-effective if the incremental cost-effectiveness ratio (ICER) was below the societal willingness-to-pay (WTP) threshold. Results Compared with IMRT, IMPT provided an extra 0.205 quality-adjusted life-year (QALY) at an additional cost of 34,926.6 US dollars (),andhadanICERof 170,082.4/QALY for the base case. At the current WTP of China (33,558/QALY)andacurrentIMPTtreatmentcostsof 50,000, IMPT should provide a minimum NTCP-reduction of 47.5, 50.8, 55.6, 63.3 and 77.2% to be considered cost-effective for patient age levels of 10, 20, 30, 40 and 50-year-old, respectively. For patients at the median age level, reducing the current IMPT costs (50,000)toa 30,000 level would make the minimum NTCP-reduction threshold for “cost-effective” decrease from 91.4 to 44.6%, at the current WTP of China (from 69.0 to 33.5%, at a WTP of 50,000/QALY;andfrom39.7to19.1%,ataWTPof 100,000/QALY). Conclusions Cost-effective scenarios of PBT exist in Chinese OPC patients at the current WTP of China. Considering a potential upcoming increase in PBT use in China, such cost-effective scenarios may further expand if a decrease of proton treatment costs occurs or an increase of WTP level.
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影响因子：
5.7
作者：
Grant, Stephen R.;Hutcheson, Katherine A.;Ye, Rong;Garden, Adam S.;Morrison, William H.;Rosenthal, David, I;Gunn, G. Brandon;Fuller, C. David;Phan, Jack;Reddy, Jay P.;Moreno, Amy C.;Lewin, Jan S.;Sturgis, Erich M.;Ferrarotto, Renata;Frank, Steven J.
通讯作者：
Frank, Steven J.
DOI：
10.1016/j.ijrobp.2016.02.021
发表时间：
2016-05-01
期刊：
International journal of radiation oncology, biology, physics
影响因子：
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作者：
Gunn GB;Blanchard P;Garden AS;Zhu XR;Fuller CD;Mohamed AS;Morrison WH;Phan J;Beadle BM;Skinner HD;Sturgis EM;Kies MS;Hutcheson KA;Rosenthal DI;Mohan R;Gillin MT;Frank SJ
通讯作者：
Frank SJ
影响因子：
4.5
作者：
Kerstiens, John;Johnstone, Gregory P.;Johnstone, Peter A. S.
通讯作者：
Johnstone, Peter A. S.
DOI：
10.1016/j.ijrobp.2016.06.010
发表时间：
2017-03-15
影响因子：
7
作者：
Goepfert, Ryan P.;Lewin, Jan S.;Barrow, Martha P.;Gunn, G. Brandon;Fuller, C. David;Beadle, Beth M.;Garden, Adam S.;Rosenthal, David I.;Kies, Merrill S.;Papadimitrakopoulou, Vassiliki;Lai, Stephen Y.;Gross, Neil D.;Schwartz, David L.;Hutcheson, Katherine A.
通讯作者：
Hutcheson, Katherine A.
DOI：
10.1016/j.ijrobp.2018.11.039
发表时间：
2019-07-01
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Brodin NP;Kabarriti R;Pankuch M;Schechter CB;Gondi V;Kalnicki S;Guha C;Garg MK;Tomé WA
通讯作者：
Tomé WA