With the cost of cancer treatment making constant headlines and hundreds of million of dollars being invested into new proton therapy centers around the world, it’s tempting to believe some experts who tout the cancer treatment as the latest contributor to healthcare’s skyrocketing costs.
That’s just not true, says Scott Warwick, vice president for strategic initiatives and program development for Provision Healthcare and chair of the National Association for Proton Therapy.
“People look at the cost of some proton therapy centers being built and assume because it’s so much more expensive to set up than conventional radiation that it is directly reflected in the cost to the patient,” he says. “That’s not exactly the way it works.”
The majority of proton therapy centers are freestanding rather than connected to medical centers. Medicare sets the rate it will pay for the service including the facility, equipment, personnel costs, supplies, geographic location, insurance and other direct and indirect expenses. It is not based solely on the price tag of the center and equipment. Private insurance companies individually negotiate with providers like Provision based on the rates Medicare sets for that facility.
Additionally, many of the centers receive significant philanthropic gifts to support the construction of the facility and purchase of the equipment. The Mayo Clinic, for example, received more than $100 million to support its new proton facility. This substantially reduces the cost to develop a proton therapy center.
And while initially proton therapy was more expensive than the conventional radiation it competed with, newer methods of delivering the therapy have reduced the number of treatments required and, thus, the cost of service.
Hypfractionation refers to the method of treating patients with the same prescribed dose of radiation with two-thirds to one-third treatments. Because of proton therapy’s ability to precisely target tumors with limited exposure to surrounding tissues, there are less side effects with treatment, which make it the ideal modality for hypofractionation.
For example, a study at MD Anderson Cancer Center showed a hypofractionated protocol for breast cancer cost $13,833 compared to the $19,599 cost of conventional radiation. Medicare reimbursement rates for hypofractionated treatment of prostate cancer show the cost of proton therapy at $26,050 with the cost of conventional radiation at a comparable $24,420. At Provision, prostate patients who choose hypfractionation cut their number of treatments from 39 to 20.
Harder to quantify are the cost savings from the reduced side effects and reduced radiation exposure proton therapy offers. For head and neck cancers, proton therapy reduces patient weight loss and the need for feeding tubes—factors that dramatically reduce the gap between proton and x-ray therapy, particularly toward the end of treatment. Proton therapy reduces the risk of pneumonitis, esophagitis, heart disease and secondary cancers due to radiation exposure for lung cancer patients. Recent studies show women treated for breast cancer using conventional radiation receive damaging doses to the heart and lungs. Pediatric patients see a long list of physical and neurological benefits from proton therapy.
Another MD Andersen study compared the cost of proton therapy and radiation in the case of patients with head and neck cancer, concluding the proton therapy cost just 6 percent more than intensity-modulated radiation therapy when taking into account the healthcare costs associated with weight loss, feeding tubes placement and resulting treatment re-planning and re-simulation because of greater side effects associated with IMRT.
This impact on a patient’s life after cancer is known as “quality-adjusted life years,” but Warwick agrees that’s difficult to quantify.
“It is difficult to put a price on improving someone’s quality of life,” he says. “It is a very inexact science and often varies in the eye of the beholder. It is easy to minimize having a feeding tube placed into your abdomen until you’re the one having the procedure performed.”
And yet, people—and their health insurance companies—are willing to pay for much costlier chemotherapy treatments to prolong life, if only for a few weeks or months. He cites an example of a drug for metastatic prostate cancer, shown to extend life on average by four months. The cost: $90,000.
“That’s double the cost or more for most proton therapy cases,” he says. “And this drug receives robust coverage from most commercial insurance payers, even though it is not even used to cure the cancer.”