When to wait for more evidence? Real options analysis in proton therapy

Area of Science:

• Health Economics
• Oncology
• Decision Analysis

Background:

• Rising cancer care costs necessitate evaluating new technologies.
• Adopting novel, expensive treatments like proton therapy presents a dilemma due to limited initial evidence.
• The decision to adopt or delay is complex, especially when reversal costs are high.

Purpose of the Study:

• To apply real options analysis to the adoption decision for proton therapy versus stereotactic body radiotherapy for inoperable stage I non-small cell lung cancer.
• To determine the optimal strategy among adopting, adopting with a trial, or delaying adoption with a trial.

Main Methods:

• A real options analysis framework was employed.
• Calculated expected net gain for each adoption option (adopt, adopt with trial, delay with trial).
• Considered costs of treatment, research, and decision reversal.

Main Results:

• In the Netherlands, the preferred option was to adopt proton therapy with a concurrent trial, requiring approximately 200 patients.
• Increased international treatment costs and reversal expenses influenced the optimal decision.

Conclusions:

• Real options analysis offers a transparent framework for evaluating the cost-benefit trade-offs of adopting new, high-cost medical technologies.
• This method aids in making informed decisions regarding the adoption and further research of innovative cancer therapies.