| Autor: |
Jones, DA, Candio, P, Shakir, R, Ramroth, J, Wolstenholme, J, Gray, AM, Cutter, DJ, Ntentas, G |
| Rok vydání: |
2023 |
| Předmět: |
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| Zdroj: |
Clinical Oncology. 35:301-310 |
| ISSN: |
0936-6555 |
| Popis: |
Purpose: Radiotherapy (RT) for Hodgkin lymphoma leads to the incidental irradiation of organs-at-risk (OAR) which may confer excess risks of late effects. Comparative dosimetry studies show that proton beam therapy (PBT) may reduce OAR irradiation compared to photon-RT, but PBT is more expensive and treatment capacity is limited. This study’s purpose is to inform the appropriateness of PBT for intermediate-stage Hodgkin lymphoma (ISHL). Methods: A microsimulation model simulating the course of ISHL, background mortality, and incidence and mortality of other diseases was used to estimate comparative QALYs lived and healthcare costs after consolidative PBT or photon-RT, both in deep inspiration breath hold (DIBH). Outcomes were compared for 606 illustrative patients covering a spectrum of clinical presentations, varying by two age strata (20y and 40y), both sexes, three smoking statuses (never, former, and current), and 61 pairs of OAR radiation doses from a comparative planning study. Both undiscounted and discounted outcomes at 3.5% yearly discount were estimated. The maximum excess cost of PBT that might be considered cost-effective by the UK’s National Institute for Health and Care Excellence was calculated. Findings: OAR doses, smoking status and discount rate had large impacts on QALYs gained with PBT. Current smokers benefited the most, averaging 0.605 undiscounted QALYs (range -0.341 to 2.171) and 0.146 discounted QALYs (range -0.067 to 0.686) whereas never smokers benefited the least, averaging 0.074 undiscounted QALYs (range -0.196 to 0.491) and 0.017 discounted QALYs (range -0.030 to 0.086). For the gain in discounted QALYs to be considered cost-effective, PBT would have to cost at most £4812 more than photon-RT for current smokers and £645 more for never smokers. This is below preliminary NHS cost estimates of PBT over photon-RT. Conclusion: In a UK setting PBT for ISHL may not be considered cost-effective. However, the degree of unquantifiable uncertainty is substantial. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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