Table 6.

Cost-effectiveness studies for proton vs photon therapy of brain tumors

Author [ref]	year	Tumor type	Study design	Statistical Model Method	Included Parameters	Results
Lundkvist et al.110	2005	Pediatric medulloblastoma	Comparison PBT vs IMRT	Markov cohort simulation model	Risk of hearing loss, IQ loss, GHD, hypothyroidism, osteoporosis, cardiac disease, fatal and nonfatal SMN	Gain of QUALY of 0.68 per patient; Estimated cost difference (protons vs photons) per patient −23,646.5 EUR ICER of −34,622 EUR/QUALY →Cost effective →Cost saving
Mailhot Vega et al.111	2013	Pediatric medulloblastoma	Comparison of PBT vs photon RT	Monte Carlo simulation	Risk of GHD, hearing loss, hypothyroidism, congestive heart failure coronary artery disease, ACTH deficiency, gonadotropin deficiency, SMN, death	Gain of QUALY of 3.46; Total difference in costs (protons vs photons): - 32,579.1 Dollar ICER of −9,416 Dollar/QUALY →Cost effective →Cost saving
Hirano et al.112	2014	Pediatric medulloblastoma	Comparison of PBT vs IMRT	Markov cohort simulation model	Risk of hearing loss due to cochlear dose for three different QoL measures (EQ-5D, HUI3, SF-6D)	Gain of QUALY between 0.98 and 1.82 and ICER of 11,773 and 21,716 Dollar/QUALY dependent on QoL measure used →Cost effective
Mailhot Vega et al.113	2015	Pediatric CNS tumors	Comparison of PBT vs photon RT in hypothalamic dose sparing	Markov cohort simulation model	Risk of GHD	Hypothalamic proton doses between 5 and 25 Gy can be cost-effective, between 5 and 20 Gy even cost saving in some scenarios

ACTH, adrenocorticotropic hormone; GHD, growth hormone deficiency; ICER, incremental cost-effectiveness ratio; IMRT, intensity modulated radiation therapy; IQ, intelligence quotient; PBT, proton beam therapy; QoL, quality of life; QUALY, quality adjusted life years; RT, radiation therapy; SMN, secondary malignant neoplasm.