Proton Beam Therapy a Cost-Effective Treatment for Some Cancer Types

Proton beam therapy (PBT) represents a promising, cost-effective option for patients with specific forms of cancer, according to a recently published review. 

PBT is increasingly being use for the treatment of cancer in the United States. Whereas 10 years ago there were only 4 facilities capable of performing the technique, today 16 centers use it, and, by 2020, it is estimated that there will be more than 90 operational facilities worldwide. However, because of rising cancer costs, there are concerns that the growth of PBT centers may not be sustainable in the future. 

Studies of PBT have shown that it can be effective for treating cancer while sparing more healthy tissue than other radiotherapy methods. Still, the benefits of the technique versus other treatments have not been fully demonstrated. Additionally, most research has focused on the clinical benefits of the technique while leaving out cost data. This has made it difficult to determine whether PBT is cost-effective for the treatment of cancer.

In an article published in Cancer, researchers conducted the first systematic review of the cost-effectiveness of PBT. The authors, led by Minesh P Mehta, MBChB, University of Maryland, Baltimore, performed searches of various abstracts and medical indexing sites to find applicable data for analyzing costs and outcomes associated with PBT.

As expected, limited data on cost and PBT were available for review. However, the authors were able to identify some relevant studies that provided insight of PBT use in several cancer types.

In prostate cancer—the most common diagnosis currently treated with PBT—researchers determined that the cost-effectiveness of PBT use was sub-optimal.  “It is important to consider this lack of a proven [cost-effectiveness] benefit for prostate cancer given the relative ubiquity of patients receiving prostate PBT treatments throughout the United States and around the world,” the authors wrote.

For several types of pediatric brain tumors, PBT was the most cost-effective option. Analysis of the use of PBT for breast cancer showed that it was only marginally more costly than whole-breast irradiation and had superior cost-effectiveness for certain subsets of patients. Cost-effectiveness was also superior to that of accelerated partial breast irradiation, a technique where focused radiation beams are targeted at tumor resection sites.

For non–small cell lung cancer, head and neck cancers, esophageal cancer, pediatric cancers, skull base cancers, and uveal melanoma, the cost-effectiveness of PBT compared with other treatments varied between patient subpopulations and was highly dependent on staging as well as the risks for treatment-related toxicities. For patients with oropharyngeal and nasopharyngeal cancers, PBT led to a 50% reduction in the use of gastrostomy feeding tubes, improving quality of life for patients and with manageable costs.

The researchers concluded that careful patient selection is critical to assess the cost-effectiveness of PBT for different cancer types. They also noted that the current availability of data in this area is greatly limited, suggesting that future cost-effectiveness analyses  could differ greatly as PBT becomes more available, clinical trial evidence accumulates, and the technology improves.—Sean McGuire   

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Verma V, Mishra MV, Mehta MP. A systematic review of the cost and cost-effectiveness studies of proton radiotherapy. [Published online February 1, 2016]. Cancer. 2016. doi: 10.1002/cncr.29882.