Publication year
2013Source
International Journal of Radiation Oncology, Biology, Physics, 85, 5, (2013), pp. 1282-8ISSN
Publication type
Article / Letter to editor

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Organization
Health Evidence
Operating Rooms
Former Organization
Epidemiology, Biostatistics & HTA
Journal title
International Journal of Radiation Oncology, Biology, Physics
Volume
vol. 85
Issue
iss. 5
Page start
p. 1282
Page end
p. 8
Subject
NCEBP 2: Evaluation of complex medical interventionsAbstract
PURPOSE: To use Normal Tissue Complication Probability (NTCP) models and comparative planning studies to explore the (cost-)effectiveness of swallowing sparing intensity modulated proton radiotherapy (IMPT) compared with swallowing sparing intensity modulated radiotherapy with photons (IMRT) in head and neck cancer (HNC). METHODS AND MATERIALS: A Markov model was constructed to examine and compare the costs and quality-adjusted life years (QALYs) of the following strategies: (1) IMPT for all patients; (2) IMRT for all patients; and (3) IMPT if efficient. The assumption of equal survival for IMPT and IMRT in the base case analysis was relaxed in a sensitivity analysis. RESULTS: Intensity modulated proton radiation therapy and IMRT for all patients yielded 6.620 and 6.520 QALYs and cost euro50,989 and euro41,038, respectively. Intensity modulated proton radiation therapy if efficient yielded 6.563 QALYs and cost euro43,650. The incremental cost-effectiveness ratio of IMPT if efficient versus IMRT for all patients was euro60,278 per QALY gained. In the sensitivity analysis, IMRT was more effective (0.967 QALYs) and less expensive (euro8218) and thus dominated IMPT for all patients. CONCLUSIONS: Cost-effectiveness analysis based on normal tissue complication probability models and planning studies proved feasible and informative and enables the analysis of individualized strategies. The increased effectiveness of IMPT does not seem to outweigh the higher costs for all head-and-neck cancer patients. However, when assuming equal survival among both modalities, there seems to be value in identifying those patients for whom IMPT is cost-effective.
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- Academic publications [227425]
- Faculty of Medical Sciences [86157]
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