Utilization of proton therapy: evidence-based, market-driven, or something in-between?

Proton therapy (PT) is a potentially promising, but costly, radiation modality. Assessment of such new health technologies is becoming increasingly important in the era of constrained budgets. This study attempts to establish how PT utilization might fit into the existing radiation oncology armamentarium.

All patients treated in 2007 with radiation therapy at an academic institution were individually evaluated as potential PT candidates. Seven potential adoption scenarios were developed, ranging from PT being superior (A), to being clinically reasonable with some published evidence (B1-B3), to being clinically appealing but without published evidence (C). Two sensitivity analyses (D and E) were also performed.

One thousand forty-two patients were treated using 19,749 treatment fractions. PT could be used in 6% of treatment courses and 3% of treatment fractions in scenario A, in 12% and 7% in scenario B1, in 17% and 17% in scenario B2, in 8% and 17% in scenario B3, in 24% and 30% in scenario C, in 37% and 30% in scenario D, and 67% and 79% in scenario E. Introduction of PT would increase treatment delivery cost over baseline by 2%, 2%, 18%, 27%, 45%, 29%, and 141%, respectively.

The degree of PT utilization would depend on the strictness of selection criteria, and would likely range from 6% to 25%, with concomitant cost increase from minimal to 40%. Ultimate adoption of PT in the United States may depend on individual facilities and payors performing similar analyses and setting individual adoption criteria.