METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches were conducted in PUBMED, EMBASE and SCOPUS till February 2022. Original pharmacoeconomic articles written in English that considered PBT for HNC were included; the title, abstract and full text of the search items were screened. The included studies were critically appraised using the Drummond Checklist followed by data extraction.
RESULTS: Eight of the ten included studies were of good quality; most were cost-effectiveness or cost comparison studies and used the Markov model and lifetime horizon. The dominant comparator was intensity-modulated radiotherapy. The willingness to pay threshold ranged from $30,828 to $150,000 per QALY. The incremental cost-effectiveness ratio (ICER) was between $4,436.1 and $695,000 per QALY. In HNC patients with human papillomavirus infection, the ICER was lower ($288,000/QALY) from the payer\'s perspective, but much higher ($390,000/QALY) from the societal perspective.
CONCLUSIONS: Our systematic review showed that appropriate patient selection can make PBT cost-effective. HPV-associated tumors can be cost-effectively treated with PBT. From the payer\'s perspective, PBT is a cost-effective treatment option. In younger patients, PBT can result in lesser incidence of adverse effects, and hence, can reduce the subsequent need for long-term supportive care. Lower fractionation schedules can also make PBT a cost-effective treatment.
方法:本系统评价按照系统评价和荟萃分析指南的首选报告项目进行。在PUBMED进行了系统搜索,EMBASE和SCOPUS至2022年2月。包括以英文撰写的原版药物经济学文章,其中考虑了HNC的PBT;标题,摘要和全文的搜索项目进行了筛选。纳入的研究使用Drummond清单进行严格评估,然后进行数据提取。
结果:纳入的10项研究中有8项质量良好;大多数是成本效益或成本比较研究,并使用马尔可夫模型和生命周期。主要比较器是调强放疗。每个QALY的支付意愿门槛从30,828美元到150,000美元不等。增量成本效益比(ICER)在每QALY4,436.1美元至695,000美元之间。在人乳头瘤病毒感染的HNC患者中,从付款人的角度来看,ICER较低(28.8万美元/QALY),但从社会角度来看要高得多(390,000美元/季度)。
结论:我们的系统评价显示,适当的患者选择可以使PBT具有成本效益。HPV相关肿瘤可以用PBT经济有效地治疗。从付款人的角度来看,PBT是一种具有成本效益的治疗选择。在年轻患者中,PBT可以降低不良反应的发生率,因此,可以减少后续对长期支持性护理的需求。较低的分馏时间表也可以使PBT成为一种具有成本效益的治疗方法。