Cost-Effectiveness of Intensity-Modulated Proton Therapy (IMPT) for the Treatment of Head and Neck Oropharyngeal Carcinoma
Author(s)
Mehdi Hemmati, PhD1, Seyyed Mostafa Mousavi Janbeh Sarayi, PhD2, Iakovos Toumazis, PhD2, Matthew S. Ning, MD, MPH2, Menna Y. Teffera, MS2, Noveen Ausat, MS2, Rasha M. Sareyeldin, PhD3, Mike Hernandez, MS2, Robert Foote, MD4, Paul Busse, MD, PhD5, David Rosenthal, MD, FACR, FASTRO2, Samir H. Patel, MD6, James W. Snider, MD7, Brandon Gunn, MD2, James Molitaris, MD, PhD8, Upendra Parvathenini, MD9, Shalin J. Shah, MD2, Jay P. Reddy, MD, PhD2, Alexander Lin, MD10, Nancy Lee, MD, FASTRO11, Gregory Chronowski, MD2, Mark McDonald, MD12, Noah Kalmans, MD13, Sanford Katz, MD14, Gopal K. Bajaj, MD15, Christian Hyde, MD, DABR16, Christina E. Henson, MD17, Roi Dagan, MD, MS18, Mohammed Nasiruddin, MD19, Adam S. Garden, MD2, Clifton D. Fuller, MD, PhD2, Daniel J. Ma, MD4, Steven J. Frank, MD2.
1University of Oklahoma, Norman, OK, USA, 2University of Texas MD Anderson Cancer Center, Houston, TX, USA, 3Qatar University, Doha, Qatar, 4Mayo Clinic, Rochester, MN, USA, 5Massachusetts General Hospital, Boston, MA, USA, 6Mayo Clinic, Phoenix, AZ, USA, 7Proton International, Jacksonville, FL, USA, 8University of Maryland, Baltimore, MD, USA, 9University of Texas Medical Branch, Galveston, TX, USA, 10University of Pennsylvania, Philadelphia, PA, USA, 11Memorial Sloan Kettering Cancer Center, New York, NY, USA, 12Emory University, Atlanta, GA, USA, 13Baptist Health Miami Cancer Institute, Miami, FL, USA, 14Willis Knighton Cancer Center, Shreveport, LA, USA, 15Inova Center for Personalized Health, Woodburn, VA, USA, 16McLaren Proton Therapy Center, Flint, MI, USA, 17University of Oklahoma Health Science Center, Oklahoma City, OK, USA, 18University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA, 19Northwestern Medical Group, Warrenville, IL, USA.
1University of Oklahoma, Norman, OK, USA, 2University of Texas MD Anderson Cancer Center, Houston, TX, USA, 3Qatar University, Doha, Qatar, 4Mayo Clinic, Rochester, MN, USA, 5Massachusetts General Hospital, Boston, MA, USA, 6Mayo Clinic, Phoenix, AZ, USA, 7Proton International, Jacksonville, FL, USA, 8University of Maryland, Baltimore, MD, USA, 9University of Texas Medical Branch, Galveston, TX, USA, 10University of Pennsylvania, Philadelphia, PA, USA, 11Memorial Sloan Kettering Cancer Center, New York, NY, USA, 12Emory University, Atlanta, GA, USA, 13Baptist Health Miami Cancer Institute, Miami, FL, USA, 14Willis Knighton Cancer Center, Shreveport, LA, USA, 15Inova Center for Personalized Health, Woodburn, VA, USA, 16McLaren Proton Therapy Center, Flint, MI, USA, 17University of Oklahoma Health Science Center, Oklahoma City, OK, USA, 18University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA, 19Northwestern Medical Group, Warrenville, IL, USA.
OBJECTIVES: To evaluate the cost-effectiveness of chemoradiation strategies with intensity-modulated proton therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for the treatment of advanced stage head and neck oropharyngeal carcinoma (OPC).
METHODS: A cohort state-transition model was developed and informed based on the outcomes of a multi-centered, randomized, Phase III clinical trial of OPC treatment (IMPT vs. IMRT) for patients diagnosed with advanced OPC. State-transition probabilities were computed based on the 5-year survival analysis, stratified by treatment arms. Ten toxicities and their corresponding 3-month incidence rates were considered based on the trial data: dysphagia, xerostomia, dysgeusia, fatigue, weight loss, oral pain, mucositis, nausea, dermatitis, and vomiting. Work productivity assessment index (WPAI) was collected and analyzed for employment after treatment and associated federal taxes paid annually. The incremental cost-effectiveness ratio (ICER) was computed from the societal perspective by estimating costs (including treatment costs such as induction chemotherapy, costs associated with health states, loss-of-productivity costs, and toxicity-management costs estimated using U.S. Centers for Medicare & Medicaid Services data) and quality-adjusted life years (QALYs). An extreme gradient boosting (XGBoost)-based model was developed to derive patients’ MD Anderson Symptom Inventory (MDASI) scores, a multi-symptom patient-reported outcome measure for quality of life. Literature-reported utilities associated with the core health states were further adjusted as needed using the MDASI scores. Sensitivity analysis was performed under the assumption of similar survival rates between the arms.
RESULTS: With a 5-year horizon, the cohort costs associated with the IMPT arm were $114,234 (versus $92,199 for IMRT), with 4.34 QALYs (versus 4.21 QALYs for IMRT), resulting in an ICER below $100,000 per QALY (ICER=$44,335). The ICER remained below $100,000 per QALY (ICER=$76,105) when similar survival rates between the arms were assumed.
CONCLUSIONS: IMPT is more cost-effective than IMRT in the management of head and neck OPC, warranting further consideration.
METHODS: A cohort state-transition model was developed and informed based on the outcomes of a multi-centered, randomized, Phase III clinical trial of OPC treatment (IMPT vs. IMRT) for patients diagnosed with advanced OPC. State-transition probabilities were computed based on the 5-year survival analysis, stratified by treatment arms. Ten toxicities and their corresponding 3-month incidence rates were considered based on the trial data: dysphagia, xerostomia, dysgeusia, fatigue, weight loss, oral pain, mucositis, nausea, dermatitis, and vomiting. Work productivity assessment index (WPAI) was collected and analyzed for employment after treatment and associated federal taxes paid annually. The incremental cost-effectiveness ratio (ICER) was computed from the societal perspective by estimating costs (including treatment costs such as induction chemotherapy, costs associated with health states, loss-of-productivity costs, and toxicity-management costs estimated using U.S. Centers for Medicare & Medicaid Services data) and quality-adjusted life years (QALYs). An extreme gradient boosting (XGBoost)-based model was developed to derive patients’ MD Anderson Symptom Inventory (MDASI) scores, a multi-symptom patient-reported outcome measure for quality of life. Literature-reported utilities associated with the core health states were further adjusted as needed using the MDASI scores. Sensitivity analysis was performed under the assumption of similar survival rates between the arms.
RESULTS: With a 5-year horizon, the cohort costs associated with the IMPT arm were $114,234 (versus $92,199 for IMRT), with 4.34 QALYs (versus 4.21 QALYs for IMRT), resulting in an ICER below $100,000 per QALY (ICER=$44,335). The ICER remained below $100,000 per QALY (ICER=$76,105) when similar survival rates between the arms were assumed.
CONCLUSIONS: IMPT is more cost-effective than IMRT in the management of head and neck OPC, warranting further consideration.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE71
Topic
Economic Evaluation
Disease
SDC: Oncology