Transferability of patient selection model for proton radiation therapy to lower-income European countries

Németh, Bertalan (author), Delnoij, Diana M. J. (author), Došenović Bonča, Petra (author), Hren, Rok (author)

Objectives: Proton therapy is an alternative treatment to photon therapy in head and neck cancer. The Normal Tissue Complication Probability (NTCP) model assists in the patient selection process. This study explores how health technology assessment (HTA) recommendations in lower-income European countries (LIECs) in head and neck cancer can be supported by transferring the NTCP model. Methods: Through 2 workshops in November 2022 and May 2023, the scope of transferability recommendations was established for the head and neck cancer case study of the HTx project. HTA experts from LIECs and HTx consortium rep- resentatives reviewed draft recommendations at a final transferability workshop in November 2023. Experts anonymously voted on the main challenges of transferring the NTCP model to LIECs and ranked these by importance. Finally, an open discussion took place about potential solutions for overcoming the main challenges. Results: Main challenges of transferring the NTCP model to LIECs include lack of available local data, differences in patient pathways, and shortage of HTA experts. Workshop participants agreed that the NTCP model is an improvement to current standard HTA methods. Multiple key recommendations were formed, including that dissemination of real-world data and real-world evidence should be gold standard, coupled with a wide collaboration across stakeholders, and that consideration of transferability aspects could help LIECs when adapting novel methods. Conclusions: According to a multinational panel of experts, the NTCP model is an improvement over current HTA methods. To overcome challenges of its adoption in LIECs, 5 key recommendations were formulated.

• Language: English
• Keywords: Central and Eastern Europe, health care, costs, economic aspect, central and Eastern European countries, head and neck cancer, health technology assessment, normal tissue, complication probability model, transferability
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: EF - School of Economics and Business
• Publication status: In print
• Publication version: Version of Record
• Year: 2026
• PID: 20.500.12556/RUL-182203
• UDC: 614.2
• ISSN on article: 2212-1102
• DOI: 10.1016/j.vhri.2026.101628
• COBISS.SI-ID: 276721923
• Publication date in RUL: 30.04.2026

Record is a part of a journal

• Title: Value in health regional issues
• Publisher: Elsevier
• ISSN: 2212-1102
• COBISS.SI-ID: 4777791

Licences

• License: CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
• Link: http://creativecommons.org/licenses/by-nc-nd/4.0/
• Description: The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.

Secondary language

• Language: Slovenian
• Keywords: srednja in vzhodna Evropa, zdravstveno varstvo, stroški, ekonomski vidik

Projects

• Funder: EC - European Commission
• Project number: 825162
• Name: Next Generation Health Technology Assessment to support patient-centred, societally oriented, real-time decision-making on access and reimbursement for health technologies throughout Europe
• Acronym: HTx