Individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness
Abstract Introduction The significantly greater cost of proton therapy compared with X‐ray therapy is frequently justified by the expected reduction in normal tissue toxicity. This is often true for indications such as paediatric and skull base cancers. However, the benefit is less clear for other m...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-03-01
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| Series: | Journal of Medical Radiation Sciences |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jmrs.416 |
| _version_ | 1818928495403728896 |
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| author | Annabelle M. Austin Michael J.J. Douglass Giang T. Nguyen Lisa Cunningham Hien Le Yvonne Hu Scott N. Penfold |
| author_facet | Annabelle M. Austin Michael J.J. Douglass Giang T. Nguyen Lisa Cunningham Hien Le Yvonne Hu Scott N. Penfold |
| author_sort | Annabelle M. Austin |
| collection | DOAJ |
| description | Abstract Introduction The significantly greater cost of proton therapy compared with X‐ray therapy is frequently justified by the expected reduction in normal tissue toxicity. This is often true for indications such as paediatric and skull base cancers. However, the benefit is less clear for other more common indications such as breast cancer, and it is possible that the degree of benefit may vary widely between these patients. The aim of this work was to demonstrate a method of individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness of treatment. Methods 16 left‐sided breast cancer patients had a treatment plan generated for the delivery of intensity‐modulated proton therapy (IMPT) and of intensity‐modulated photon therapy (IMRT) with the deep inspiration breath‐hold (DIBH) technique. The resulting dosimetric data was used to predict probabilities of tumour control and toxicities for each patient. These probabilities were used in a Markov model to predict costs and the number of quality‐adjusted life years expected as a result of each of the two treatments. Results IMPT was not cost‐effective for the majority of patients but was cost‐effective where there was a greater risk reduction of second malignancies with IMPT. Conclusion The Markov model predicted that IMPT with DIBH was only cost‐effective for selected left‐sided breast cancer patients where IMRT resulted in a significantly greater dose to normal tissue. The presented model may serve as a means of evaluating the cost‐effectiveness of IMPT on an individual patient basis. |
| first_indexed | 2024-12-20T03:29:49Z |
| format | Article |
| id | doaj.art-f88f2a6881cd4940b4845d5d9cc9418b |
| institution | Directory Open Access Journal |
| issn | 2051-3895 2051-3909 |
| language | English |
| last_indexed | 2024-12-20T03:29:49Z |
| publishDate | 2021-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Medical Radiation Sciences |
| spelling | doaj.art-f88f2a6881cd4940b4845d5d9cc9418b2022-12-21T19:55:01ZengWileyJournal of Medical Radiation Sciences2051-38952051-39092021-03-01681445110.1002/jmrs.416Individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectivenessAnnabelle M. Austin0Michael J.J. Douglass1Giang T. Nguyen2Lisa Cunningham3Hien Le4Yvonne Hu5Scott N. Penfold6Department of Physics University of Adelaide Adelaide SA AustraliaDepartment of Physics University of Adelaide Adelaide SA AustraliaSchool of Mathematical Sciences University of Adelaide Adelaide SA AustraliaDepartment of Radiation Oncology Royal Adelaide Hospital Adelaide SA AustraliaDepartment of Radiation Oncology Royal Adelaide Hospital Adelaide SA AustraliaDepartment of Radiation Oncology Royal Adelaide Hospital Adelaide SA AustraliaDepartment of Physics University of Adelaide Adelaide SA AustraliaAbstract Introduction The significantly greater cost of proton therapy compared with X‐ray therapy is frequently justified by the expected reduction in normal tissue toxicity. This is often true for indications such as paediatric and skull base cancers. However, the benefit is less clear for other more common indications such as breast cancer, and it is possible that the degree of benefit may vary widely between these patients. The aim of this work was to demonstrate a method of individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness of treatment. Methods 16 left‐sided breast cancer patients had a treatment plan generated for the delivery of intensity‐modulated proton therapy (IMPT) and of intensity‐modulated photon therapy (IMRT) with the deep inspiration breath‐hold (DIBH) technique. The resulting dosimetric data was used to predict probabilities of tumour control and toxicities for each patient. These probabilities were used in a Markov model to predict costs and the number of quality‐adjusted life years expected as a result of each of the two treatments. Results IMPT was not cost‐effective for the majority of patients but was cost‐effective where there was a greater risk reduction of second malignancies with IMPT. Conclusion The Markov model predicted that IMPT with DIBH was only cost‐effective for selected left‐sided breast cancer patients where IMRT resulted in a significantly greater dose to normal tissue. The presented model may serve as a means of evaluating the cost‐effectiveness of IMPT on an individual patient basis.https://doi.org/10.1002/jmrs.416breast cancercost‐effectivenessMarkov modelproton therapyradiobiological models |
| spellingShingle | Annabelle M. Austin Michael J.J. Douglass Giang T. Nguyen Lisa Cunningham Hien Le Yvonne Hu Scott N. Penfold Individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness Journal of Medical Radiation Sciences breast cancer cost‐effectiveness Markov model proton therapy radiobiological models |
| title | Individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness |
| title_full | Individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness |
| title_fullStr | Individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness |
| title_full_unstemmed | Individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness |
| title_short | Individualised selection of left‐sided breast cancer patients for proton therapy based on cost‐effectiveness |
| title_sort | individualised selection of left sided breast cancer patients for proton therapy based on cost effectiveness |
| topic | breast cancer cost‐effectiveness Markov model proton therapy radiobiological models |
| url | https://doi.org/10.1002/jmrs.416 |
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