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Cost-effectiveness of proton therapy in treating base of skull chordoma

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Abstract

While proton beam therapy (PBT) can offer increased sparing of healthy tissue, it is associated with large capital costs and as such, has limited availability. Furthermore, it has not been well established whether PBT has significant clinical advantages over conventional volumetric modulated arc therapy (VMAT) for all tumour types. PBT can potentially offer improved clinical outcomes for base of skull chordoma (BOSCh) patients compared with photon (X-ray) therapy, however the cost-effectiveness of these treatments is unclear. In this study, the cost-effectiveness of PBT in the treatment of BOSCh patients is assessed, based on an analysis of comparative radiotherapy treatment plans using a radiobiological Markov model. Seven BOSCh patients had treatment plans for the delivery of intensity modulated proton therapy and VMAT retrospectively analysed. The patient outcome (in terms of tumour local control and normal tissue complications) after receiving each treatment was estimated with a radiobiological Markov model. In addition, the model estimated the cost of both the primary treatment and treating any resultant adverse events. The incremental cost-effectiveness ratio (ICER) was obtained for each patient. PBT was found to be cost-effective for 5 patients and cost-saving for 2. The mean ICER was AUD$1,990 per quality adjusted life year gained. Variation of model parameters resulted in the proton treatments remaining cost-effective for these patients. Based on this cohort, PBT is a cost-effective treatment for patients with BOSCh. This supports the inclusion of PBT for BOSCh in the Medicare Services Advisory Committee 1455 application.

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Fig. 1

Adapted from Austin et al. [8]

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Acknowledgements

The authors wish to thank Peter Rhodes for the early development of the project. The first author acknowledges the support of an Australian Government Research Training Program Scholarship. The third author acknowledges the support of ACEMS (ARC Centre of Excellence for Mathematical and Statistical Frontiers).

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Authors and Affiliations

  1. Department of Physics, University of Adelaide, North Terrace, Adelaide, SA, Australia

    Annabelle M. Austin, Michael J. J. Douglass & Scott N. Penfold

  2. Department of Medical Physics, Royal Adelaide Hospital, Adelaide, SA, Australia

    Michael J. J. Douglass & Scott N. Penfold

  3. School of Mathematical Sciences, University of Adelaide, Adelaide, SA, Australia

    Giang T. Nguyen

  4. Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia

    Raymond Dalfsen, Hien Le, Peter Gorayski, Hui Tee & Michael Penniment

Authors
  1. Annabelle M. Austin
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  2. Michael J. J. Douglass
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  3. Giang T. Nguyen
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  4. Raymond Dalfsen
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  5. Hien Le
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  8. Michael Penniment
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  9. Scott N. Penfold
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Correspondence to Annabelle M. Austin.

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Conflict of interest

Scott Penfold has worked part-time for a developer of a proton therapy centre. The other authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Royal Adelaide Hospital Research Ethics Committee No. 150322) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Austin, A.M., Douglass, M.J.J., Nguyen, G.T. et al. Cost-effectiveness of proton therapy in treating base of skull chordoma. Australas Phys Eng Sci Med 42, 1091–1098 (2019). https://doi.org/10.1007/s13246-019-00810-0

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  • DOI: https://doi.org/10.1007/s13246-019-00810-0

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