Cost-Effectiveness Models of Proton Therapy for Head and Neck: Evaluating Quality and Methods to Date

Huang, Danmeng; Frank, Steven J.; Verma, Vivek; Thaker, Nikhil G.; Brooks, Eric D.; Palmer, Matthew; Harrison, Ross; Deshmukh, Ashish A.; Ning, Matthew S.

doi:10.14338/ijpt-20-00058.1

Cited by 9 publications

(3 citation statements)

References 47 publications

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“…Existen aproximaciones pormenorizadas a la evaluación de coste efectividad de protonterapia en cáncer de cabeza y cuello. La protonterapia, como modalidad que mediante beneficio dosimétrico puede minimizar la toxicidad aguda y crónica en tratamientos intensivos, introduce un modelo de análisis metodológico comparativo sofisticado, con criterio 360, es decir niveles de gasto interdisciplinares nano-micro-meso-macroscópico (42). Beneficio sintomático (atoxicidad o diferencial inferior de toxicidad entre modalidades de tratamiento), impacta en coste e impacta en menor sufrimiento (un valor en alza en la búsqueda de implementar humanización en la medicina de precisión).…”

Section: "Costicidad"unclassified

Proton therapy and cancer: clinical horizon 2030 in Spain

Calvo Manuel,

Gómez Caamaño,

Ferrer Albiach

et al. 2023

an. ranm

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Proton therapy is the external beam irradiation technique that, by providing extreme dosimetric accuracy, minimises exposure to unnecessary disperse ionising radiation effects to normal, non-cancerous tissues. This technology requires high-cost investments, but its rate of implementation has been exponential over the last 15 years. In 2023, proton therapy will have a competitive business portfolio in the international healthcare environment: more than 128 active centres (46 in the USA). The progression of clinical activity in proton therapy identifies the following sequence: more than 55,000 patients treated until 2006, more than 75,000 in 2010, more than 100,000 in 2014 and 312,000 in May 2023. In addition, 38 proton therapy centres under construction and 29 in planning (including the next 10 planned in the National Health System, SNS) are registered. The most robust clinical evidence published since 2010 has been reviewed. Among the studies evaluated (>30,000 patients analysed), mature results are observed, reproducible among expert institutions, where the dosimetric benefit allows establishing levels of clinical benefit in the context of the dynamism of multimodal cancer treatment. The 2030 clinical horizon of proton therapy in Spain, will be aligned to the international impulse of the last two decades, but in an exceptional context of availability of the technological resource due to the recent donation to the SNS of 10 proton therapy units by the Amancio Ortega Foundation. This singular (admirable) action of sponsorship does impulse the promotion of health in the Spanish population and will allow extreme technological availability, literally at the patient’s bedside. The Spanish Society of Radiation Oncology has the compromise to impulse research, development, and innovation at the service of the patients and society.

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Section: "Costicidad"unclassified

Proton therapy and cancer: clinical horizon 2030 in Spain

Calvo Manuel,

Gómez Caamaño,

Ferrer Albiach

et al. 2023

an. ranm

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“…In addition, numerous studies are being conducted to determine the cost effectiveness of proton therapy. [113][114][115] While the upfront cost may be significantly higher, considering outcomes, toxicities, and hospitalization rates after radiotherapy, the overall value of proton therapy may be competitive with photon therapy, especially once it achieves its potential. Furthermore, the cost effectiveness may vary significantly from patient to patient, and it is important to identify patients for whom proton therapy will have the greatest benefit.…”

Section: Technological Limitations and Ongoing Advancementsmentioning

confidence: 99%

A review of proton therapy – Current status and future directions

Mohan

2022

Precision Radiation Oncology

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The original rationale for proton therapy was its highly conformal depth‐dose distributions compared to photons, which allow greater sparing of normal tissues and escalation of tumor doses, thus potentially improving outcomes. Additionally, recent research has revealed previously unrecognized advantages of proton therapy. For instance, the higher relative biological effectiveness (RBE) near the end of the proton range can be exploited to increase the difference in biologically effective dose in tumors versus normal tissues. Moreover, the smaller “dose bath,” that is, the compact nature of proton dose distributions, has been found to reduce the exposure of circulating lymphocytes and the immune organs at risk. There is emerging evidence that the resulting sparing of the immune system has the potential to improve outcomes. Protons accelerated to energies ranging from 70 to 250 MeV enter the treatment head mounted typically on a rotating gantry. Initially, the beams of protons are narrow and, to be suitable for treatments, must be spread laterally and longitudinally and shaped appropriately. Such spreading and shaping may be accomplished electro‐mechanically for the “passively scattered proton therapy” (PSPT) mode; or it may be achieved through magnetic scanning of thin “beamlets” of protons. Intensities of scanning beamlets are optimized to deliver intensity‐modulated proton therapy (IMPT), which optimally balances tumor dose and the sparing of normal tissues. IMPT is presumably the most powerful form of proton therapy. The planning and evaluation of proton dose distributions require substantially different techniques compared to photon therapy. This is mainly due to the fact that proton dose distributions are highly sensitive to inter‐ and intra‐fractional variations in anatomy. In addition, for the same physical dose, the biological effectiveness of protons is different from photons. In the current practice of proton therapy, the RBE is simplistically assumed to have a constant value of 1.1. In reality, the RBE is variable and a highly complex function of numerous variables including energy of protons, dose per fraction, tissue and its environment, cell type, end point, and possibly other factors. While the theoretical potential of proton therapy is high, the clinical evidence in support of its use has so far been mixed. The uncertainties and assumptions mentioned above and the limitations of the still evolving technology of proton therapy may have diminished its true clinical potential. Although promising results have been reported for many types of cancers, they are often based on small studies. At the same time, there have been reports of unforeseen toxicities. Furthermore, because of the high cost of proton therapy, questions are often raised about its value. The general consensus is that there is a need for continued improvement in the state of the art of proton therapy. There is also a need to generate high level evidence of the potential of protons. Fortuitously, such efforts are taking place curr...

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“…In addition, there is still insufficient knowledge about the reduction of late radiation-induced side effects and secondary tumor induction, which is particularly relevant for young patients with good prognosis. Furthermore, uncertainties in the assumptions underlying the cost-effectiveness analyses can limit interpretation and applicability [ 113 ]. The limitations of cost-effectiveness analyses can be countered by using time-driven activity-based costing (TDABC), a bottom-up cost accounting method that measures the cost of resources used based on the actual time that personnel and equipment are used to treat patients.…”

Section: Costs-effectiveness Of Proton Therapymentioning

confidence: 99%

Proton Therapy for Squamous Cell Carcinoma of the Head and Neck: Early Clinical Experience and Current Challenges

Nuyts

Bollen

et al. 2022

Cancers

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Proton therapy (PT) is a promising development in radiation oncology, with the potential to further improve outcomes for patients with squamous cell carcinoma of the head and neck (HNSCC). By utilizing the finite range of protons, healthy tissue can be spared from beam exit doses that would otherwise be irradiated with photon-based treatments. Current evidence on PT for HNSCC is limited to comparative dosimetric analyses and retrospective single-institution series. As a consequence, the recognized indications for the reimbursement of PT remain scarce in most countries. Nevertheless, approximately 100 PT centers are in operation worldwide, and initial experiences for HNSCC are being reported. This review aims to summarize the results of the early clinical experience with PT for HNSCC and the challenges that are currently faced.

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Cost-Effectiveness Models of Proton Therapy for Head and Neck: Evaluating Quality and Methods to Date

Cited by 9 publications

References 47 publications

Proton therapy and cancer: clinical horizon 2030 in Spain

Proton therapy and cancer: clinical horizon 2030 in Spain

A review of proton therapy – Current status and future directions

Proton Therapy for Squamous Cell Carcinoma of the Head and Neck: Early Clinical Experience and Current Challenges

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