The cost-effectiveness of particle therapy in non-small cell lung cancer: Exploring decision uncertainty and areas for future research

Grutters, Janneke P.C.; Pijls-Johannesma, Madelon; Ruysscher, Dirk De; Peeters, Andrea; Reimoser, Stefan; Severens, Johan L.; Lambin, Philippe; Joore, Manuela A.

doi:10.1016/j.ctrv.2010.02.018

« Previous Next »Cancer Treatment Reviews
Volume 36, Issue 6 , Pages 468-476, October 2010

The cost-effectiveness of particle therapy in non-small cell lung cancer: Exploring decision uncertainty and areas for future research

Janneke P.C. Grutters
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- Department of Health Organization, Policy and Economics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Corresponding author. Address: Department of Health Organization, Policy and Economics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 433881973; fax: +31 433670960.
Madelon Pijls-Johannesma
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- Tel.: +31 884455666; fax: +31 884455667.
Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- Tel.: +31 884455666; fax: +31 884455667.
Andrea Peeters
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- Tel.: +31 884455666; fax: +31 884455667.
Stefan Reimoser
- Turner and Townsend GmbH, St.-Martin-Straße 76, 81541 München, Germany
- Tel.: +49 89 636 86928; fax: +49 89 636 81973.
Johan L. Severens
- Department of Health Organization, Policy and Economics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Tel.: +31 433882907; fax: +31 433670960.
Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 1588, 6201 BN Maastricht, The Netherlands
- These authors contributed equally to this work.
- Tel.: +31 884455666; fax: +31 884455667.
Manuela A. Joore
- Department of Health Organization, Policy and Economics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- These authors contributed equally to this work.
- Tel.: +31 43 3875434; fax: +31 43 3874419.

Received 11 January 2010; received in revised form 17 February 2010; accepted 23 February 2010. published online 19 March 2010.

Summary

Purpose

To review and synthesize all available evidence in order to explore the cost-effectiveness of particle therapy (carbon-ions, protons) compared to the best current treatments for non-small-cell lung cancer (NSCLC), and the value of additional research. The present study focuses on stage I NSCLC, as no data is available for more advanced stages.

Methods

A probabilistic decision-analytic Markov model was constructed to synthesize all available evidence. Comparative treatments were carbon-ions, protons, conventional radiotherapy (CRT) and stereotactic radiotherapy (SBRT) for inoperable stage I NSCLC; and carbon-ions and SBRT for operable stage I NSCLC. The expected value of perfect information (EVPI) was calculated to support research decisions.

Results

For inoperable stage I NSCLC, carbon-ion therapy costed €67.257 per quality-adjusted-life-year gained compared to SBRT. Both treatments dominated protons and CRT. Considerable uncertainty surrounded these results, resulting in a high EVPI. For operable stage I NSCLC SBRT dominated carbon-ion therapy.

Conclusions

Due to the considerable uncertainty in stage I NSCLC, and the lack of data on more advanced stages, it is recommended not to adopt particle therapy as standard treatment in NSCLC yet. More evidence is needed to reduce the decision uncertainty and to support evidence-based treatment decisions. It might be worthwhile to invest in a particle facility for clinical research. Future research should also weigh the investment risk, value of information and costs of delay.

Keywords: Economic evaluation, Particle therapy, Protons, Carbon-ions, Lung cancer, Evidence synthesis