Cost-effectiveness analysis (CEA) of IMRT plus C12 boost vs IMRT only in adenoid cystic carcinoma (ACC) of the head and
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RESEARCH
Open Access
Cost-effectiveness analysis (CEA) of IMRT plus C12 boost vs IMRT only in adenoid cystic carcinoma (ACC) of the head and neck A D Jensen1,2,3* and Jürgen Debus3
Abstract Background: Particle therapy provides steep dose gradients to facilitate dose escalation in challenging anatomical sites which has been shown not only to improve local control but also overall survival in patients with ACC. Costeffectiveness of intensity-modulated radiotherapy (IMRT) plus carbon ion (C12) boost vs IMRT alone was performed in order to objectivise and substantiate more widespread use of this technology in ACC. Methods: Patients with pathologically confirmed ACC received a combination regimen of IMRT plus C12 boost. Patients presenting outside C12 treatment slots received IMRT only. Clinical results were published; economic analysis on patientlevel data was carried out from a healthcare purchaser’s perspective based on costs of healthcare utilization. Cost histories were generated from resource use recorded in individual patient charts and adjusted for censoring using the Lin I method. Cost-effectiveness was measured as incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed regarding potentially differing management of recurrent disease. Results: The experimental treatment increased overall costs by € 18,076 (€13,416 – €22,922) at a mean survival benefit of 0.86 years. Despite improved local control, following costs were also increased in the experimental treatment. The ICER was estimated to 26,863 €/LY. After accounting for different management of recurrent disease in the two cohorts, the ICER was calculated to 20,638 €/LY. Conclusion: The combined treatment (IMRT+C12 boost) substantially increased initial and overall treatment cost. In view of limited treatment options in ACC, costs may be acceptable though. Investigations into quality of life measures may support further decisions in the future. Keywords: Cost-effectiveness, CEA, IMRT, C12, Adenoid cystic carcinoma, ACC, Malignant salivary gland tumours, MSGTs
Background Treatment with charged particles is a comparatively new and expensive radiotherapy technology. Construction and operational costs of particle facilities are estimated at more than twice the costs of standard photon therapy facilities [1–4], hence particle therapy is available in few * Correspondence: [email protected] 1 Department of Radiation Oncology, University Hospital Gießen and Marburg GmbH (UKGM), Philipps-University of Marburg, Baldingerstraße, D-35032 Marburg, Germany 2 Department of Social Policy, London School of Economics, Houghton Street, London WC2A 2AE, UK Full list of author information is available at the end of the article
specialised centres only. It is used to treat comparatively radioresistant tumours at complex anatomical sites [5– 7] where dose escalation with photon radiotherapy is limited by normal tissue tolerance [7, 8]. In contrast to photons, charged particles such as protons or carbon ions (C12) loose most of their energy at the end of
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