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Decision analytic modeling for the economic analysis of proton radiotherapy for non-small cell lung cancer

	author = {Wade P. Smith and Patrick J. Richard and Jing Zeng and Smith Apisarnthanarax and Ramesh Rengan and Mark H. Phillips},
	title = {Decision analytic modeling for the economic analysis of proton radiotherapy for non-small cell lung cancer},
	journal = {Translational Lung Cancer Research},
	volume = {7},
	number = {2},
	year = {2018},
	keywords = {},
	abstract = {Background: Although proton radiation treatments are more costly than photon/X-ray therapy, they may lower overall treatment costs through reducing rates of severe toxicities and the costly management of those toxicities. To study this issue, we created a decision-model comparing proton vs. X-ray radiotherapy for locally advanced non-small cell lung cancer patients.
Methods: An influence diagram was created to model for radiation delivery, associated 6-month pneumonitis/esophagitis rates, and overall costs (radiation plus toxicity costs). Pneumonitis (age, chemo type, V20, MLD) and esophagitis (V60) predictors were modeled to impact toxicity rates. We performed toxicity-adjusted, rate-adjusted, risk group-adjusted, and radiosensitivity analyses.
Results: Upfront proton treatment costs exceeded that of photons [\$16,730.37 (3DCRT), \$23,893.83 (IMRT), \$41,061.80 (protons)]. Based upon expected population pneumonitis and esophagitis rates for each modality, protons would be expected to recover \$1,065.62 and \$1,139.63 of the cost difference compared to 3DCRT or IMRT. For patients treated with IMRT experiencing grade 4 pneumonitis or grade 4 esophagitis, costs exceeded patients treated with protons without this toxicity. 3DCRT patients with grade 4 esophagitis had higher costs than proton patients without this toxicity. For the risk group analysis, high risk patients (age 65, carboplatin/paclitaxel) benefited more from proton therapy. A biomarker may allow patient selection for proton therapy, although the AUC alone is not sufficient to determine if the biomarker is clinically useful. 
Conclusions: The comparison between proton and photon/X-ray radiation therapy for NSCLC needs to consider both the up-front cost of treatment and the possible long term cost of complications. In our analysis, current costs favor X-ray therapy. However, relatively small reductions in the cost of proton therapy may result in a shift to the preference for proton therapy.},
	issn = {2226-4477},	url = {}