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

Danmeng Huang; Steven J Frank; Vivek Verma; Nikhil G Thaker; Eric D Brooks; Matthew B Palmer; Ross F Harrison; Ashish A Deshmukh; Matthew S Ning

doi:10.14338/IJPT-20-00058.1

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

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

Authors

Danmeng Huang^{1

2}, Steven J Frank¹, Vivek Verma¹, Nikhil G Thaker³, Eric D Brooks⁴, Matthew B Palmer⁵, Ross F Harrison⁶, Ashish A Deshmukh², Matthew S Ning¹

Affiliations

¹ Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
² Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, USA.
³ Arizona Oncology, Tucson, AZ, USA.
⁴ University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA.
⁵ Legion Healthcare Partners, Houston, TX, USA.
⁶ Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

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.

Grants and funding

P30 CA016672/CA/NCI NIH HHS/United States