Evidence map›Paper›PMID 33478544›Full record

ArticleRadiation oncology (London, England)2021

Individualized quality of life benefit and cost-effectiveness estimates of proton therapy for patients with oropharyngeal cancer.

N Patrik Brodin, Rafi Kabarriti, Clyde B Schechter, Mark Pankuch, Vinai Gondi, Shalom Kalnicki, Madhur K Garg, Wolfgang A Tomé

Open access · goldAbstract read
In one paragraph

Article in Radiation oncology (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
1.7field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 11 citations in OpenAlex.

  1. Pooled it
  2. A Systematic Review of the Economic Burden of Proton Therapy in Head and Neck Cancer.Asian Pacific journal of cancer prevention : APJCP · 2023
    Pooled it
  3. [Proton versus photon radiotherapy for patients with oropharyngeal cancer].Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026
    Article
  4. Article
  5. Article
  6. Proton Beam Radiation Therapy for Oropharyngeal Squamous Cell Carcinoma.International journal of particle therapy · 2023
    Review
  7. It is beneficial to invest resources to implement proton intracranial SRS.Journal of applied clinical medical physics · 2022
    Article
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

N Patrik BrodinInstitute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA. patrik.brodin@einsteinmed.org.
Rafi KabarritiInstitute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
Clyde B SchechterDepartment of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
Mark PankuchNorthwestern Medicine Chicago Proton Center, Warrenville, IL, 60555, USA.
Vinai GondiNorthwestern Medicine Chicago Proton Center, Warrenville, IL, 60555, USA.
Shalom KalnickiDepartment of Radiation Oncology, Montefiore Medical Center, Bronx, NY, 10461, USA.
Madhur K GargInstitute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
Wolfgang A ToméInstitute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY, 10461, USA. wolfgang.tome@einsteinmed.org.
Albert Einstein College of Medicine · USMontefiore Medical Center · USNorthwestern Medicine · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProton therapy is a promising advancement in radiation oncology especially in terms of reducing normal tissue toxicity, although it is currently expensive and of limited availability. Here we estimated the individual quality of life benefit and cost-effectiveness of proton therapy in patients with oropharyngeal cancer treated with definitive radiation therapy (RT), as a decision-making tool for treatment individualization. METHODS AND MATERIALS: Normal tissue complication probability models were used to estimate the risk of dysphagia, esophagitis, hypothyroidism, xerostomia and oral mucositis for 33 patients, comparing delivered photon intensity-modulated RT (IMRT) plans to intensity-modulated proton therapy (IMPT) plans. Quality-adjusted life years (QALYs) lost were calculated for each complication while accounting for patient-specific conditional survival probability and assigning quality-adjustment factors based on complication severity. Cost-effectiveness was modeled based on upfront costs of IMPT and IMRT, and the cost of acute and/or long-term management of treatment complications. Uncertainties in all model parameters and sensitivity analyses were included through Monte Carlo sampling.

resultsThe incremental cost-effectiveness ratios (ICERs) showed considerable variability in the cost of QALYs spared between patients, with median $361,405/QALY for all patients, varying from $54,477/QALY to $1,508,845/QALY between individual patients. Proton therapy was more likely to be cost-effective for patients with p16-positive tumors ($234,201/QALY), compared to p16-negative tumors ($516,297/QALY). For patients with p16-positive tumors treated with comprehensive nodal irradiation, proton therapy is estimated to be cost-effective in ≥ 50% of sampled cases for 8/9 patients at $500,000/QALY, compared to 6/24 patients who either have p16-negative tumors or receive unilateral neck irradiation.

conclusionsProton therapy cost-effectiveness varies greatly among oropharyngeal cancer patients, and highlights the importance of individualized decision-making. Although the upfront cost, societal willingness to pay and healthcare administration can vary greatly among different countries, identifying patients for whom proton therapy will have the greatest benefit can optimize resource allocation and inform prospective clinical trial design.

Indexed as

Proton TherapyQuality of LifeCost-Benefit AnalysisHealth Care CostsHumansOropharyngeal NeoplasmsQuality-Adjusted Life YearsRadiotherapy, Intensity-ModulatedCost-effectivenessIndividualized risk-assessmentProton therapyQuality of life

Identifiers

PMID33478544
PMCPMC7819210
OpenAlexW3125501812

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.