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. 2021 Jun 25;8(1):339-353.
doi: 10.14338/IJPT-20-00058.1. eCollection 2021 Summer.

Cost-Effectiveness Models of Proton Therapy for Head and Neck: Evaluating Quality and Methods to Date

Danmeng Huang  1   2 , Steven J Frank  1 , Vivek Verma  1 , Nikhil G Thaker  3 , Eric D Brooks  4 , Matthew B Palmer  5 , Ross F Harrison  6 , Ashish A Deshmukh  2 , Matthew S Ning  1
Affiliations

Cost-Effectiveness Models of Proton Therapy for Head and Neck: Evaluating Quality and Methods to Date

Danmeng Huang et al. Int J Part Ther. .

Abstract

Purpose: Proton beam therapy (PBT) is associated with less toxicity relative to conventional photon radiotherapy for head-and-neck cancer (HNC). Upfront delivery costs are greater, but PBT can provide superior long-term value by minimizing treatment-related complications. Cost-effectiveness models (CEMs) estimate the relative value of novel technologies (such as PBT) as compared with the established standard of care. However, the uncertainties of CEMs can limit interpretation and applicability. This review serves to (1) assess the methodology and quality of pertinent CEMs in the existing literature, (2) evaluate their suitability for guiding clinical and economic strategies, and (3) discuss areas for improvement among future analyses.

Materials and methods: PubMed was queried for CEMs specific to PBT for HNC. General characteristics, modeling information, and methodological approaches were extracted for each identified study. Reporting quality was assessed via the Consolidated Health Economic Evaluation Reporting Standards 24-item checklist, whereas methodologic quality was evaluated via the Philips checklist. The Cooper evidence hierarchy scale was employed to analyze parameter inputs referenced within each model.

Results: At the time of study, only 4 formal CEMs specific to PBT for HNC had been published (2005, 2013, 2018, 2020). The parameter inputs among these various Markov cohort models generally referenced older literature, excluding many clinically relevant complications and applying numerous hypothetical assumptions for toxicity states, incorporating inputs from theoretical complication-probability models because of limited availability of direct clinical evidence. Case numbers among study cohorts were low, and the structural design of some models inadequately reflected the natural history of HNC. Furthermore, cost inputs were incomplete and referenced historic figures.

Conclusion: Contemporary CEMs are needed to incorporate modern estimates for toxicity risks and costs associated with PBT delivery, to provide a more accurate estimate of value, and to improve their clinical applicability with respect to PBT for HNC.

Keywords: comparative analysis; health care value; health economics; oropharyngeal cancer; proton beam therapy.

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Conflict of interest statement

Conflicts of Interest: Steven J. Frank, MD, is an Associate Editor of the International Journal of Particle Therapy. Outside of the submitted work, Dr Frank reports receiving personal fees as a consultant and advisory board member of Varian Medical Systems, Inc; grants and personal fees as director and founder of C4 Imaging, LLC; grants and honoraria as an advisor for Hitachi; honoraria from Boston Scientific; grants from Eli Lilly; grants from Elekta; honoraria from Augmenix; personal fees as a member of the board of directors of the National Comprehensive Cancer Center (NCCN); and other support as a scientific advisory board member for Breakthrough Chronic Care. Ashish A. Deshmukh PhD, MPH, reports receiving consulting fees from Merck on unrelated projects outside the submitted work. The authors have no additional conflicts of interest to disclose.

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