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This study aimed to determine the cost\u2010effectiveness of PBT for unresectable, locally advanced pancreatic cancer (LAPC) as a replacement for conventional photon radiotherapy (RT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We estimated the incremental cost\u2010effectiveness ratio (ICER) of PBT as a replacement for three\u2010dimensional conformal RT (3DCRT), a conventional photon RT, using clinical evidence in the literature and expense complemented by expert opinions. We used a decision tree and an economic and Markov model to illustrate the disease courses followed by LAPC patients. Effectiveness was estimated as quality\u2010adjusted life years (QALY) using utility weights for the health state. Social insurance fees were calculated as the costs. The stability of the ICER against the assumptions made was appraised using sensitivity analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The effectiveness of PBT and 3DCRT was 1.67610615 and 0.97181271 QALY, respectively. The ICER was estimated to be \u00a55,376,915 (US$46,756) per QALY. According to the suggested threshold for anti\u2010cancer therapy from the Japanese authority of \u00a57,500,000 (US$65,217) per QALY gain, such a replacement would be considered cost\u2010effective. The one\u2010way and probabilistic sensitivity analyses demonstrated stability of the base\u2010case ICER.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PBT, as a replacement for conventional photon radiotherapy, is cost\u2010effective and justifiable as an efficient use of finite healthcare resources. Making it a standard treatment option and available to every patient in Japan is socially acceptable from the perspective of health economics.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.6611","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T19:53:43Z","timestamp":1696535623000},"page":"20450-20458","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Analysis of the cost\u2010effectiveness of proton beam therapy for unresectable pancreatic cancer in Japan"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4040-0127","authenticated-orcid":false,"given":"Yuichi","family":"Hiroshima","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology &amp; Proton Medical Research Center, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"},{"name":"QST hospital, National Institutes for Quantum and Radiological Sciences and Technology  Chiba Chiba Japan"},{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital  Kasama Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahide","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy and Health Economics, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Sawada","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology &amp; Proton Medical Research Center, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu\u2010ling","family":"Hoshi","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy and Health Economics, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reiko","family":"Okubo","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy and Health Economics, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"},{"name":"Department of Clinical Laboratory Medicine University of Tsukuba Hospital  Tsukuba Ibaraki Japan"},{"name":"Department of Nephrology, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Iizumi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology &amp; Proton Medical Research Center, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruko","family":"Numajiri","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology &amp; Proton Medical Research Center, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiyuki","family":"Okumura","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology &amp; Proton Medical Research Center, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"},{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital  Kasama Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideyuki","family":"Sakurai","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology &amp; Proton Medical Research Center, Faculty of Medicine University of Tsukuba  Tsukuba Ibaraki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,5]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21654"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-14-0155"},{"key":"e_1_2_13_4_1","unstructured":"Cancer Information Service NCC Japan (Vital Statistics of Japan).Cancer Registry and Statistics. 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