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Abstract：
BACKGROUND: Radiation therapy is used to treat head and neck cancer (HNC) patients. Proton beam therapy (PBT) is one of the newer treatment options. This systematic review will describe the cost and cost-effectiveness of PBT compared with other first-line treatment options based on available literature and provide a better understanding of its usage in HNC in the future.
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.
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.
摘要：
背景：放射治疗用于治疗头颈癌（HNC）患者。质子束疗法（PBT）是较新的治疗选择之一。本系统综述将根据现有文献描述PBT与其他一线治疗方案相比的成本和成本效益，并更好地了解其在未来HNC中的使用情况。
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。
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。
