A systematic review of the cost and cost‐effectiveness studies of proton radiotherapy

Abstract

Group of North America for both years of existence (2014)(2015). Eighteen original investigations were analyzed. RESULTS: The costeffectiveness for prostate cancer-the single most common diagnosis currently treated with PBT-was suboptimal. PBT was the most cost-effective option for several pediatric brain tumors. PBT costs for breast cancer were increased but were favorable for appropriately selected patients with left-sided cancers at high risk of cardiac toxicity and compared with brachytherapy for accelerated partial breast irradiation. For non-small cell lung cancer (NSCLC), the greatest cost-effectiveness benefits using PBT were observed for locoregionally advanced-but not early stage-tumors. PBT offered superior cost-effectiveness in selected head/neck cancer patients at higher risk of acute mucosal toxicities. Similar cost-effectiveness was observed for PBT, enucleation, and plaque brachytherapy in patients with uveal melanoma. CONCLUSIONS: With greatly limited amounts of data, PBT offers promising cost-effectiveness for pediatric brain tumors, well-selected breast cancers, locoregionally advanced NSCLC, and high-risk head/neck cancers. Heretofore, it has not been demonstrated that PBT is cost-effective for prostate cancer or early stage NSCLC. Careful patient selection is absolutely critical to assess cost-effectiveness. Together with increasing PBT availability, clinical trial evidence, and ongoing major technological improvements, cost-effectiveness data and conclusions from this analysis could change rapidly. Cancer 2016;122:1483

Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review

“…In this phase III trial, the decreased post-therapy hospitalization rate provides a pertinent endpoint for which PBT was clearly superior to TACE; these results have major implications for cost-effectiveness (77). Taken together, partially as a result of the relatively greater volume of published data on PBT for HCC, there have been recommendations recently proposed regarding PBT for various "levels" of HCC (incorporating staging, performance and Child-Pugh status, vascular invasion, etc.)…”

“…Finally, dosimetric and clinical differences in proton pencil beam scanning versus passive scattering have only begun to be investigated (85). With greater time and clinical experience, however, answers to fundamental technical aspects of PBT may leave less outstanding questions and more streamlining of PBT, which can drive down the treatment costs that are known to be a major logistical hurdle for PBT implementation (77).…”

Cancer patients need better care, not just more technology

“…Each machine costs around $140 million 12 . These same countries currently have an average deficit of around 60% in both human resources and equipment for basic radiotherapy, which is much more effective in increasing cure rates and relieving suffering 13 .…”

Three ways to make proton therapy affordable

“…Patient charges are high, often three to four times more than the priciest X-ray treatments. Fewer patients are being treated with protons than was anticipated: common diseases such as prostate cancer can be cured as effectively using other forms of radiation and surgery 4 . And in the United States, major insurance companies are denying proton therapy to up to 30% of eligible patients 5 on the basis that there are too few rigorously designed and completed clinical trials providing evidence of better outcomes.…”