Bladder cancer (Superficial, Infiltrating, Metastatic disease) considered as the Secondary malignancy induced by the PC treatment.

 

         Bladder cancer treatment

 

          low-risk disease: 1.1 k€ for a Trans Uretral Resection (2 hospital admissions)

           high-risk disease: 17.2 k€ for a Trans Uretral Resection + 1 year of intravescical Bacillus Calmette-Guerin (BCG) immunotherapy + a radical         cystectomy (Cys) + 6 cycles of chemotherapy with Gemcitabine plus Cisplatin (about 60 hospital admissions)

Cost-Effectiveness Analysis for Protontherapy

The Risk

 

The Risk of post-treated Cancer (RISKPC) is related to Organ Equivalent Dose concept:

 

EAR= EAR₀ × OED

EAR = Excess Absolute Risk to develop a secondary solid cancer after radiothepy

OED = Organ Equivalent Dose

 

Two models was used to define the Dose-Response relationship for radiation induced cancer calculated from the Dose Volume Histograms: Linear (for minimum RISKPC) and Linear-Exponential ((for maximum RISKPC)

 

Costs (in k€) and Effectiveness (in Quality Adjusted Life Year, QALY) by technology

Comparison of 5 competing treatment options:

 

3 types of radiotherapy (photons) and 2 types (protons) to analyze a 50 years-old patient treated for a prostatic carcinoma (PC) rT3:

 

3D-Conformal RadioTherapy, 3D-CRT

 

Intensity Modulated RadioTherapy, IMRT

 

Volumetric Modulated Arc Therapy, VMAT

 

Intensity Modulated ProtonTherapy, IMPT

 

Single Field, Uniform Dose, SFUD

Cost-effectiveness modeling

 

* TreeAge Pro Health Care Decision Software

* 1000 patients hypothetical cohort

 

Markov model constructed on several health states: post-treatment primary cancer, disease progression with hormone and chemotherapy, second primary cancer treatment and post treatment, cystectomy, second primary cancer progression with hormone and chemotherapy, death.

The results indicates an economic advantage for the proton therapy with respect to the photon radio therapy on the National Health System, mainly due to the long term higher risk of a second primary cancer induced from the treatment of PCa and the related, higher, treatment costs (this is particularly relevant for the young men with long life expectancy).

 

The energy deposition trends of protons and neutrons in the volume of water along the beam axis from MCNPX simulation for the TOP-IMPLART.

The energy deposition of the secondary dose is very low and involves an increase factor of about one thousandth on the calculated RISKPC

The Markov Tree

 

SFUD subtree detail

Cost-Effectiveness Analysis of Protontherapy vs Advanced Radiotherapy available in Italy for cancer treatment considering the Risk of Second radio-induced  Cancer and the related costs with the reimbursement of the Italian National Health System.

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