From the May 2011 issue of HealthCare Business News magazine


Should protons expand?
Of course, there remains the question of whether there should be more facilities.

“My basic argument with regard to protons, before they’re generally accepted, they need to be studied,” said Dr. Joel E. Tepper, a radiation oncologist and cancer researcher with University of North Carolina in Chapel Hill, who in 2008 won ASTRO’s prestigious gold medal for contributions to radiation oncology.
Critics contend that proton therapy might be superior to X-ray treatments, but that rigorous comparative studies need to be done to prove it. Others note the medical industry has an interest in promoting more lucrative treatments even if the evidence for their superiority to cheaper ones is lacking.

“In many of these cases, you can argue (and companies do) that the more expensive treatment will prove the better one once all the evidence is in. And sometimes it will. But sometimes it won't. In the meantime, life-and-death decisions are too often made based not on the best reading of the evidence, but on the best profit margin,” business reporter David Leonhardt wrote in the New York Times last October.

The crux of the argument is that for prostate cancer, Medicare reimburses more for proton therapy than for other radiation therapy treatment methods. The exact reimbursement schedules for the total cost of prostate cancer proton therapy versus other radiation therapy treatments are hard to come by – the Centers for Medicare and Medicaid Services told DOTmed News it tracks physician fees but not the whole cost for a course of treatment.

But estimates have been made. According to a 2009 Forbes article, Medicare pays $34,000 for protons versus $16,000 for X-rays. However, the National Association of Proton Therapy, an industry group, said the difference suggested by that article is exaggerated. The most commonly used radiation therapy technique, intensity-modulated radiation therapy, costs Medicare $42,000, while protons cost about $50,000 for a course of treatment, according to NAPT’s figures.

But other researchers have suggested that the cost-per-quality-adjusted-life-year gained doesn’t justify the slightly pricier treatment. A 2007 article in the Journal of Clinical Oncology by Dr. Andre Konski, then with the Fox Chase Cancer Center in Philadelphia, used a treatment model to argue that the mean cost of treatment for protons was $65,000 and $39,000 for IMRT, for a 60-year-old man with prostate cancer.

“Even when based on the unproven assumption that protons will permit a 10-Gy escalation of prostate dose compared with IMRT photons, proton beam therapy is not cost-effective for most patients with prostate cancer using the commonly accepted standard of $50,000[per quality-adjusted-life-year],” the researchers concluded.

May 2011 Magazine

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