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National Proton Conference covers the economics of therapy

by Loren Bonner, DOTmed News Online Editor | February 15, 2013

"When the evidence is there, we are there," said Dr. Lee Newcomer, senior vice president for oncology at United Healthcare.

Kolodziej also agreed that the proton therapy community needs to work to enhance its evidence base.

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Cost-effective care?

In an era of health care reform that's focused on improving quality and reducing costs, insurance companies want to align coverage with value and better patient outcomes.

"How do we ensure they are getting treatment that is most cost-effective for their condition," said Malin.

A more promising option for private coverage of proton therapy might be reference pricing, something insurance companies will be doing more of down the road, said Malin. Basically, this approach leaves the difference of a set price negotiated between the hospital and insurance company with the patient.

Newcomer added that all of their contracts at United Healthcare now include coverage that must be "cost-effective."

Proton therapy vs. IMRT

Policy makers would like to see evidence that shows proton beam therapy as a better or equivalent option to less costly treatments like intensity-modulated radiation therapy (IMRT), a form of X-ray radiation therapy.

"I think IMRT versus proton therapy is a fair question," said Dr. Sameer Keole, a radiation oncologist at the Mayo Clinic, during an afternoon panel discussion where he dispelled some of the negative studies about proton therapy.

Other panelists who spoke on the morning economics panel, like Dr. Andrew Lee, associate professor in the department of radiation oncology at M.D. Anderson Cancer Center Proton Center, said it was important to have evidence that stretched beyond two years, in order to evaluate the therapy's long-term outcomes.

Manufacturers in attendance have already jumped on the bandwagon, introducing technology that has a smaller footprint and is less costly.

"Our mission is to drive how to make proton therapy less expensive than IMRT," said Joe Matteo, president at Knoxville, Tenn.-based ProNova Solutions.

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