Establishing cost-effective allocation of proton therapy for breast irradiation
Menée à partir d'un modèle mathématique, cette étude estime, en fonction de l'âge des patientes et de la présence de facteurs de risque cardiaque, le rapport coût-efficacité d'une protonthérapie dans la prise en charge d'un cancer du sein
Background : Cardiac toxicity due to conventional breast radiotherapy (RT) has been extensively reported, and it impacts both life expectancy and quality-of-life for affected women. Given the favorable oncologic outcomes in the majority of women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton radiation referral. Methods : A Markov cohort model was constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40, 50, and 60-year-olds) and the presence or lack of cardiac risk factors (CRF). Model entrants could experience one of three health states: healthy, alive with coronary heart disease (CHD), or death. Base case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis (PSA) was performed to test model robustness and influence of including catheterization as a downstream possibility within the health state of CHD. Results : Proton RT was not cost-effective in women without CRFs or MHD <5Gy. Base case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6Gy with a willingness-to-pay (WTP) threshold of $100,000/Quality-Adjusted Life-Year (QALY). For women with ≥1 CRF, PSA noted preference of proton RT for MHD ≥ 5Gy with similar WTP threshold. Conclusion : Despite cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve MHD ≤5Gy.