An insight into the pharmacoeconomics of carbon ion radiotherapy: a systematic review

Purpose: Malignant diseases are among the most pressing public health challenges, exerting significant pressure on healthcare resources. Innovative cancer treatments like carbon ion radiation therapy (CIRT) by virtue of its advantages in physical properties, biological effectiveness, and dose distribution compared to photon and proton therapies stands out. This study aims to assess the cost-effectiveness of CIRT in cancer treatment by systematically reviewing existing economic evaluations. Material and Methods: The protocol is registered with PROSPERO and employed PRISMA Guidelines. Systematic searches across PubMed, Embase, and Web of Science, between January 2000 and March 2025 were conducted and CIRT pharmacoeconomic articles were included. Screening of the search results, critical quality assessment using Drummond and CHEERS checklist and data extraction were performed. Results: Out of the 10 studies included in this systematic review, seven analysed cost effectiveness and three analysed cost. Total cost for CIRT ranged from €16,937 (approx. USD 19,595) to €43,600 (approx. USD 50,443) and JPY 3,140,000 (approx. USD 20,450) to JPY 4,974,278 (approx. USD 32,396) in Germany and Japan, respectively. Seven studies assessed and reported increased effectiveness of CIRT. Reduction in CIRT technical fees, reirradiation with intensity-modulated radiation therapy,, increased survival rate with CIRT, local control rate by 60% with CIRT were found to reduce incremen-tal cost effectiveness ratio. Conclusion: Nine studies show CIRT is cost effective in non–small cell lung cancer, adenoid cystic carcinoma, head and neck cancer, skull-based chordoma, recurrent rectal cancer, and hepatocellular carcinoma. The cost-effectiveness of CIRT is likely to improve more in real-world clinical practice due to enhanced efficacy, reduced toxicity, reduced fractionation, and cost reductions.