Cost-utility of stereotactic radiation therapy versus proton beam therapy for inoperable advanced hepatocellular carcinoma

// Henry W.C. Leung 1,2 and Agnes L.F. Chan 2,3 1 Department of Radiation Oncology, An Nan Hospital, China Medical University, Tainan, Taiwan 2 Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan 3 Department of Pharmacy, An Nan Hospital, China Medical University, Tainan, Taiwan Correspondence to: Agnes L.F. Chan, email: // Keywords : proton beam, SBRT, ICER, NMB, WTP Received : October 24, 2016 Accepted : April 11, 2017 Published : April 21, 2017 Abstract The cost-utility of proton beam therapy was compared to stereotactic body radiation therapy for inoperable advanced hepatocellular carcinoma. A Markov decision-analytic model was performed following time to progression and survival using phase II trial data. Patients transitioned between three health states. Clinical outcomes were estimated for quality of life using utility estimates in the published literature and measured as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs). Real direct medical costs were extracted from the Bureau of National Health Insurance database. One-way and probabilistic sensitivity analyses assessed the impact of specific variables on the model. In the base-case scenario, the modeled median survival was 16 months for proton beam therapy and 10 months for SBRT. Proton beam therapy resulted in an additional 2.61 quality-adjusted life years (QALYs) at an incremental cost of NT$ 557,907 compared to SBRT. The ICER was NT$ 213,354 per QALY gained. The probabilistic sensitivity analysis predicted a 97 % chance of proton beam therapy being cost-effective at the willingness to pay NT$2,157,024 per QALY gained. Thus, proton beam therapy is a cost-effective therapy for inoperable advanced hepatocellular carcinoma at the willingness-to-pay threshold of Taiwan.