Cost-effectiveness of proton radiotherapy versus photon radiotherapy for non-small cell lung cancer patients: Exploring the model-based approach
Loeki Aldenhoven, Bram Ramaekers, Juliette Degens, Cary Oberije, J. Van Loon, Anne‐Marie C. Dingemans, Dirk De Ruysscher, Manuela Joore
Abstract
Introduction: Proton radiotherapy (PT) is a promising but more expensive strategy than photon radiotherapy (XRT) for the treatment of non-small cell lung cancer (NSCLC). PT is probably not costeffective for all patients. Therefore, patients can be selected using normal tissue complication probability (NTCP) models with predefined criteria. This study aimed to explore the cost-effectiveness of three treatment strategies for patients with stage III NSCLC: 1. photon radiotherapy for all patients (XRT All ); 2. PT for all patients (PT All ); 3. PT for selected patients (PT Individualized ). Methods: A decision-analytical model was constructed to estimate and compare costs and QALYs of all strategies. Three radiation-related toxicities were included: dyspnea, dysphagia and cardiotoxicity. Costs and QALY's were incorporated for grade 2 and ! 3 toxicities separately. Incremental Cost-Effectiven Ratios (ICERs) were calculated and compared to a threshold value of 80,000. Additionally, scenario, sensitivity and value of information analyses were performed. Results: PT All yielded most QALYs, but was also most expensive. XRT All was the least effective and least expensive strategy, and the most cost-effective strategy. For thresholds higher than 163,467 per QALY gained, PT Individualized was cost-effective. When assuming equal minutes per fraction (15 minutes) for PT and XRT, PT Individualized was considered the most cost-effective strategy (ICER: 76,299).