Main Session

Sep 27

PQA 02 - Pediatric Cancer, Sarcoma and Cutaneous Tumors, Medical Education & Professional Development, and Health Services Research

2323 - Proton vs. Photon Radiotherapy for Patients with Oropharyngeal Cancer in the USA: A Cost-Effectiveness Analysis

04:00pm - 05:00pm ET

Poster Hall - Exhibit Hall A

Screen: 2

POSTER

Presenter(s)

Steven Frank, MD, FASTRO - MD Anderson Cancer Center, Houston, TX

M. Hemmati¹, I. Toumazis², J. J. Lee³, S. M. M. Janbeh Sarayi², M. S. Ning⁴, R. L. Foote⁵, P. M. Busse⁶, D. I. Rosenthal⁷, A. S. Garden⁷, S. H. Patel⁸, J. W. Snider III⁹, G. B. Gunn¹⁰, J. K. Molitoris¹¹, D. J. Ma⁵, U. Parvathaneni¹², S. J. Shah¹³, A. Lin¹⁴, N. Y. Lee¹⁵, M. W. McDonald¹⁶, N. S. Kalman¹⁷, S. R. Katz¹⁸, G. K. Bajaj¹⁹, C. Henson²⁰, R. Dagan²¹, M. Hernandez²², D. Swanson²³, W. H. Morrison⁷, C. D. Fuller¹³, J. Phan⁷, A. C. Moreno⁷, A. Lee⁷, M. T. Spiotto⁷, L. L. Mayo²⁴, J. J. Liao²⁵, J. J. Paly²⁶, G. M. Chronowski⁷, J. P. Reddy², and S. J. Frank⁷; ¹university of oklahoma, norman, OK, ²The University of Texas MD Anderson Cancer Center, Houston, TX, ³The Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, ⁴Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, ⁵Department of Radiation Oncology, Mayo Clinic, Rochester, MN, ⁶Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, ⁷Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, ⁸Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, ⁹Partners in Healthcare Technology, Alpharetta, GA, ¹⁰UT MD Anderson, Houston, TX, ¹¹Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, ¹²University of Texas Medical Branch, Galveston, TX, ¹³Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, ¹⁴Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, ¹⁵Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, ¹⁶Winship Cancer Institute of Emory University, Atlanta, GA, ¹⁷Department of Oncological Sciences, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, ¹⁸Willis-Knighton Cancer Center, Shreveport, LA, United States, ¹⁹Department of Radiation Oncology, Miami Cancer Institute, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, ²⁰Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, ²¹University of Florida Health Proton Therapy Institute, Jacksonville, FL, ²²The UT MD Anderson Cancer Center, Houston, TX, ²³Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, ²⁴Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, ²⁵University of Washington Fred Hutchinson Cancer Center, Seattle, WA, ²⁶Department of Radiation Oncology, Harvard Medical School, Boston, MA

Purpose/Objective(s):

Intensity-modulated proton therapy (IMPT) has emerged as a promising alternative to intensity-modulated radiation therapy (IMRT) for the treatment of oropharyngeal cancer (OPC) of head and neck. However, wide adoption of IMPT has been limited largely due to concerns regarding higher upfront costs and inadequate findings to support improved post-treatment toxicity burden. We hypothesize that, despite its greater initial expense, IMPT is a cost-effective alternative to IMRT due to reduced treatment-related adverse events and associated downstream healthcare costs. To test this hypothesis, we evaluated the cost-effectiveness of IMPT based on the outcomes of a phase III randomized clinical trial of IMPT vs. IMRT for the treatment of OPC.

Materials/Methods:

We evaluated and compared IMPT’s five-year post-treatment outcomes for OPC patients against IMRT, from the U.S. societal perspective. A state-transition cohort model was developed and informed by a multicenter, randomized, open-label, non-inferiority phase 3 trial (NCT01893307). Health outcomes were adjusted for quality of life by patient’s health state, age, and treatment-induced toxicities. The acute and chronic impact of common radiation-induced toxicities (dermatitis, dysphagia, fatigue, mucositis, nausea, oral pain, vomiting, weight loss, and xerostomia) were incorporated in the model, informed from observed outcomes of the clinical trial. Direct costs associated with treatment, health states, toxicity management, and work productivity loss were included. Future costs and health outcomes were discounted at a 3% annual rate. Incremental cost-effectiveness ratios (ICERs) were calculated and compared against a willingness-to-pay (WTP) threshold of $179,200 per QALY (equivalent to two times the 2025 U.S. gross domestic product per capita). Univariate and probabilistic sensitivity analyses were performed to assess model uncertainty.

Results:

Over a five-year horizon, IMPT was a cost-effective alternative IMRT (ICER = $115,473) when considering IMPT has a survival benefit. IMPT remained cost-effective (ICER= $156,286) when assumed IMPT had no survival benefit over IMRT. The outcomes were most sensitive to the initial costs of IMPT and IMRT, followed by the probabilities of disease progression from no-evidence of disease to distant metastasis. IMPT was robustly cost-effective; only when the initial cost of IMPT was increased by 18.3% from its base-value was IMPT not cost-effective. IMPT was cost-effective in 70% of 10,000 Monte-Carlo simulations tested.

Conclusion:

The initial cost of IMPT is justified by improved survival and toxicity outcomes for OPC patients. Further consideration of IMPT as a cost-effective treatment for OPC patients is warranted.