Cost-effectiveness of proton radiation in the treatment of childhood medulloblastoma
Cost-effectiveness of proton radiation in the treatment of childhood medulloblastoma
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DOI：
10.1002/cncr.20844
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发表时间：
2005-02-15
期刊：
影响因子：
6.2
通讯作者：
Glimelius, B
中科院分区：
文献类型：
--
作者：
Lundkvist, J;Ekman, M;Glimelius, B
背景放射治疗是髓母细胞瘤治疗的重要组成部分;然而，在许多患者中，它与晚期不良事件的风险相关。与常规放射相比，质子放射治疗有可能降低不良事件的风险，但治疗费用较高。本研究的目的是评估质子治疗与常规放射治疗儿童髓母细胞瘤的成本效益。使用马尔可夫模拟模型评价放射治疗的后果。对患有髓母细胞瘤的5岁儿童进行随访。这些患者有几种类型的不良事件的风险，包括听力损失、智商（IQ）下降、甲状腺功能减退、生长激素缺乏症（GHD）、骨质疏松症、心脏病和继发性恶性肿瘤。这些患者也有死亡风险，并被分为正常死亡、肿瘤复发死亡、治疗相关心源性死亡、治疗相关后续肿瘤死亡或治疗相关其他死亡的风险组。进行了文献综述，以估计模型中的参数。基础病例结果显示，质子治疗与每例患者23，600欧元的成本节约和0.68额外质量调整生命年相关。分析表明，降低智商损失和生长激素缺乏症有助于最大部分的成本节约，是最重要的参数的成本效益。本研究的结果表明，质子放射治疗与常规放射治疗相比，在治疗儿童髓母细胞瘤时，如果选择合适的患者进行治疗，质子放射治疗可以是成本有效和节省费用的。然而，长期随访研究很少，需要更多关于放射治疗长期后果的信息。(C)2005年美国Cance Society。
BACKGROUND. Radiation therapy is an important component in the treatment of medulloblastorna; however, in many patients, it is associated with risk of late adverse events. Proton radiation therapy has potential to reduce the risk of adverse events compared with conventional radiation, but it is associated with a higher treatment cost. The objective of the current study was to assess the cost-effectiveness of proton therapy compared with conventional radiation therapy in the treatment of childhood medulloblastoma.METHODS. The consequences of radiation therapy were evaluated using a Markov simulation model. Children age 5 years with medulloblastorna were followed. The patients were at risk of several types of adverse events, including hearing loss, intelligence quotient (IQ) loss, hypothyroidism, growth hormone deficiency (GHD), osteoporosis, cardiac disease, and secondary malignancies. The patients also were at risk of death and were divided into risk groups for normal death, death due to tumor recurrence, treatment-related cardiac death, treatment-related subsequent tumor death, or treatment-related other death. A review of the literature was conducted to estimate the parameters in the model.RESULTS. The base-case results showed that proton therapy was associated with EURO 23,600 in cost savings and 0.68 additional quality- adjusted life-years per patient. The analyses showed that reductions in IQ loss and GHD contributed to the greatest part of the cost savings and were the most important parameters for cost-effectiveness.CONCLUSIONS. The results of the current study indicated that proton radiation therapy can be cost-effective and cost-saving compared with conventional radiation therapy in the treatment of children with medulloblastorna if the appropriate patients are selected for the therapy. However, there have been few long-term follow-up studies, and more much information on the long-term consequences of radiation therapy is needed. (C) 2005 American Cance Society.