title: Cost-effectiveness analysis of cochlear dose reduction by proton beam therapy for medulloblastoma in childhood.
abstract: BACKGROUND
  The aim of this study is to evaluate the cost-effectiveness of proton beam therapy with cochlear dose reduction compared with conventional X-ray radiotherapy for medulloblastoma in childhood.
  
  
  METHODS
  We developed a Markov model to describe health states of 6-year-old children with medulloblastoma after treatment with proton or X-ray radiotherapy. The risks of hearing loss were calculated on cochlear dose for each treatment. Three types of health-related quality of life (HRQOL) of EQ-5D, HUI3 and SF-6D were used for estimation of quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for proton beam therapy compared with X-ray radiotherapy was calculated for each HRQOL. Sensitivity analyses were performed to model uncertainty in these parameters.
  
  
  RESULTS
  The ICER for EQ-5D, HUI3 and SF-6D were $21 716/QALY, $11 773/QALY, and $20 150/QALY, respectively. One-way sensitivity analyses found that the results were sensitive to discount rate, the risk of hearing loss after proton therapy, and costs of proton irradiation. Cost-effectiveness acceptability curve analysis revealed a 99% probability of proton therapy being cost effective at a societal willingness-to-pay value.
  
  
  CONCLUSIONS
  Proton beam therapy with cochlear dose reduction improves health outcomes at a cost that is within the acceptable cost-effectiveness range from the payer's standpoint.
authors.affiliation: Tokyo Medical and Dental University, Faculty of Dentistry, School of Dentistry, 1-5-45 Yushima, Bunkyou-ku, Tokyo, 113-8510 Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Hirano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fuji
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Onoe
authors.forename: Vinay
authors.initials: V
authors.lastname: Kumar
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shirato
authors.forename: Koichi
authors.initials: K
authors.lastname: Kawabuchi
mesh_terms: D002528:Cerebellar Neoplasms / Q000191:economics* / Q000401:mortality / Q000532:radiotherapy*; D002648:Child; D003051:Cochlea / Q000528:radiation effects; D003362:Cost-Benefit Analysis / Q000145:classification / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D034381:Hearing Loss / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007564:Japan; D008297:Male; D008527:Medulloblastoma / Q000191:economics* / Q000401:mortality / Q000532:radiotherapy*; D018803:Models, Economic; D059351:Organ Sparing Treatments / Q000191:economics / Q000379:methods; D058958:Organs at Risk / Q000528:radiation effects; D061766:Proton Therapy; D011788:Quality of Life; D011832:Radiation Injuries / Q000191:economics* / Q000517:prevention & control; D011835:Radiation Protection / Q000191:economics; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000191:economics / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D011522:Protons
chemical_list: D011522:Protons
keywords: cost effectiveness; hearing loss; medulloblastoma; proton therapy