Cost-effectiveness analysis of cochlear dose reduction by proton beam therapy for medulloblastoma in childhood

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. © 2013 the author 2013. published by oxford university press on behalf of the japan radiation research society and japanese society for therapeutic radiology and oncology.