Systematic literature review of particle therapy costing: two decades of evidence on costing methods and analytical assumptions.

Abstract

Particle therapy (PT) is an advanced type of external beam radiotherapy, using charged particles such as protons or heavy ions, expectedly offering significant clinical advantages in cancer treatment. Adopting innovative technologies, such as PT, in clinical practice, requires economic evidence. Data on the actual cost of standard or innovative radiotherapy interventions are however scarce, and no guidelines exist to consistently perform costing in this field. This systematic literature review evaluates the methods used, and analytical assumptions taken and costs calculated in costing studies of PT, to inform a standardised costing framework. A comprehensive search was conducted across four databases to identify costing studies, published in English between 1/2000 and 5/2024. Data extraction focused on costing methods and analytical assumptions of the selected studies, along with reported costing figures. Studies quality was appraised applying an adapted CHEERS checklist. The selection process resulted in the inclusion of 12 studies. Considerable heterogeneity was observed in costing methods and the underlying assumptions of the analysis, resulting in highly variable cost estimates. Despite this variability, the studies had high scores in quality assessments. Based on the review results, costing recommendations aligned with accounting principles were proposed to inform future costing analyses. The review findings highlight the gap in costing practices in PT. Recommendations to consider for PT costing are proposed, but still further refinement and consensus from the community to be implemented as standardised guidelines. Such standardization is essential to facilitate robust economic evaluations and support evidence-based reimbursement decisions.