An Increasing Population of Patients With Oropharyngeal Carcinoma in China is Predicted to Benefit From Proton Beam Therapy in Terms of Cost-effectiveness Consideration 

Abstract Background: Proton beam therapy (PBT) is a new-emerging cancer treatment in China. The treatment costs are high and not yet covered by Chinese public medical insurance. The advanced form of PBT, intensity-modulated proton radiation therapy (IMPT), has been confirmed to reduce normal tissue complication probability (NTCP) compared with conventional intensity-modulated photon-radiation therapy (IMRT) in patients with oropharyngeal cancer (OPC). This study evaluated the cost-effectiveness of IMPT versus IMRT for OPC patients in China, aiming at guiding proper use of PBT. Methods: On the basis of published data, a 7-state Markov model was designed for cost-effectiveness analysis, and an evaluation of average level was performed on a base case of 56-year-old under the hypothesis that IMPT could make a 25% NTCP-reduction concerning to long-term symptomatic dysphagia and xerostomia. Model robustness was examined using probabilistic sensitivity analysis, cohort analysis and tornado diagram. One-way sensitivity analyses were performed to identify cost-effective scenarios. IMPT was considered as cost-effective if the incremental cost-effectiveness ratio (ICER) was below the societal willingness-to-pay (WTP) threshold (3 times the gross domestic product per capita / quality-adjusted life year (QALY)). Results: Compared with IMRT, IMPT could provide an extra 0.724 QALYs at an additional cost of 34,926.6 US dollars ($), and made an ICER of $48,229.8/ QALY for the base case. At current WTP level of China ($30,828/QALY), cost-effective scenarios of IMPT existed in the following independent conditions: ≥ 57.3% NTCP-reduction (IMPT compared with IMRT) in dysphagia and xerostomia; patient age ≤ 38-year-old; or the cost of IMPT ≤ $37,398.1. The estimated cost-effective population that benefit from using PBT to treat OPC increased remarkably in the past 10 years with the economic growth, and reached to 559.7 million (about 40.0% of the China’s total population) in the year 2020. Conclusions: Currently, using PBT to treat OPC could be cost-effective in considerable proportion of China’s population. Considering the economic growth, the gradual increment of medical insurance coverage, as well as the proton treatment cost reduction along with more proton facility opening in the near future, it is estimated that PBT would benefit more Chinese OPC patients with respect to cost-effectiveness.