For even the most energetic clinical xray beams available. Proton therapy in the most common pediatric noncentral. Articles were considered when referring to any european country, and published in any european language. Health economic controversy and costeffectiveness of. The pharmacoeconomics of proton pump inhibitors in ireland. Delineate the difference between proton and photon therapy dose distributions between different treatment sites. Proton therapy in nonsmall cell lung cancer springerlink. Canadian agency for drugs and technologies in health. In particular, potential radiationinduced injuries and secondary malignancies also associated to the prolonged life expectancy of patients are. Proton beam, neutron beam, and carbon ion radiotherapy. Radiation therapy represents an important approach in the therapeutic management of children and adolescents with malignant tumors and its application with modern techniques including proton beam therapy pbt is of great interest. A literature survey on costeffectiveness of proton beam. An example of the cost minimisation approach is seen when selecting the proton pump inhibitor of choice. See article on page 488 proton pump inhibitors ppis have become an indispensable part of the armoury of treating gastrooesophageal reflux disease gord.
Background proton beam therapy pbt is available in many western and asian countries, but there is no clinical, gantrybased pbt facility in canada. However, much controversy still remains as to whether its improved dosimetry translates to clinically meaningful reductions in toxicities compared to photon therapy pt. External beam radiotherapy is the recommended but expensive treatment option for localized prostate cancer. Proponents have cited the modalitys ability to spare healthy tissue, but critics have claimed the benefit gained from its use has not validated its cost in comparison with photon therapy. Analysis, cost effectiveness analysis, cost utility analysis, and cost benefit analysis. This conjecture is borne out by the metaanalysis of grutters et al. Costbenefit analysis of applied research infrastructure. The enpv of research infrastructures over the time horizon is defined as the expected difference between benefits and costs valued at shadow prices and discounted at the social discount rate it can be decomposed in two parts. Pbt unit, facility development as part of an ongoing capital project, electricity, maintenance contract, and staffing. St clair performed a dosevolume histogram dvh analysis of pcsi to xcsi and intensitymodulated xray therapy imxt csi plans in a 43monthold boy. Radiation therapy is a key component in the treatment repertoire for nsclc, where it is currently used alone or in combinations with chemotherapy and surgery. Costeffectiveness analysis cea is frequently used in health services.
Exploring decision uncertainty and areas for future research. Improving proton therapy by metalcontaining nanoparticles. Proton beam therapy pbt is a specialized form of radiation therapy rt. There is no question that prostate treatments are a unique issue in the field with respect to costbenefit analysis as the clinical advantage over conventional therapy is not clear in many cases, yet the represent a far larger pool of potential patients and thus revenue than the much more rare cancers for which the superiority of proton. Is proton beam therapy cost effective in the treatment of. Accurate identification of patients who are appropriate candidates to receive outofcountry treatment with proton beam radiation therapy. Proton beam radiation therapy clinical practice guidelines. Over the last decade, the clinical application of proton therapy pr for prostate cancer pca patients has grown rapidly. Cost effectiveness of proton versus photon radiation.
Proton beam therapy holds great promise at a steep cost. Konski et al conducted a costbenefit analysis of proton beam therapy and concluded that it would not be cost effective for most patients with adenocarcinoma of the prostate. A number of proton therapy centers are currently recruiting patients in various prospective trials and are testing proton therapy alone, comparing proton therapy vs tace, or evaluating the role of proton therapy in advanced disease. Mathematical modelling for patient selection in proton therapy. Proton beam therapy is costlier than imrt and its cost effectiveness remains unclear given the limited comparative data on outcomes. Xray photon radiation delivers substantial doses of radiation to tissues surrounding any tumor volume. Survival benefit 21 months cost of year saved usd 3,654. Modelbased costeffectiveness analysis of external beam. The costbenefit of proton versus other treatment options is worth of study given the high cost of protons. According to loma linda university medical center in california, which opened the nations first hospitalbased proton therapy center in 1990, the cost of building a multiroom proton center can be as much as 40 times that of a center that delivers conventional. Request pdf health economic controversy and costeffectiveness of proton therapy owing to increasing healthcare costs, there is a need to examine whether the benefits of new technologies are. Similarly, controversy surrounds the robustness of pr plans as well as the cost.
Conventional external beam radiotherapy uses photons to irradiate and kill tumor cells. Clinical proton mr spectroscopy in central nervous system. Nonsmall cell lung cancer nsclc accounts for 85% of new lung cancer cases and has 5year survival rates ranging from 92% in earlystage disease to as low as % in locally advanced cases. Retrospective cohort costminimization analysis payer perspective with decision analysis model to access costeffectiveness of a treatmentbased algorithm tbc for low back pain lbp compared to a usual care strategy in the outpatient. Economic evaluation of treatments for patients with. Proton therapy greatly lessens the probability of this. Less damage to healthy tissue versus xray radiation.
Proton therapy has currently used to treat brain, spinal and prostate cancers, as well as breast cancer. Despite the potential physical and biological advantages of particle therapy pt as shown in many planning studies tabulated in glimelius et al. Mathematical modelling offers assistance when selecting patients for pbt and. Robotassisted radical prostatectomy, intensitymodulated radiotherapy, and proton beam therapy for prostate cancer cost more than their traditional counterparts.
Anderson cancer center, who specializes in the treatment of prostate cancer with proton beam therapy as well as imrt, acknowledged that the study is. A costeffectiveness study is needed given the excessive cost of radiotherapy treatment and the high prevalence of prostate cancer. Costbenefit analysis is an analytical tool aimed at informing decision making on the economic viability of. The swedish analysis computed an icer of 26,800qaly and concluded that proton therapy for prostate cancer may be costeffective, provided an appropriate patient selection. Giuseppe battistoni, mario genco, marta marsilio, chiara pancotti, sandro rossi. If the new technologies can consistently achieve better outcomes, then they may be cost effective. Prostate cancer is the most common cancer in men worldwide. Proton beam therapy pbt has been in use for many decades. Usa hampton, va hampton university proton therapy institute p 2010 1200 dec 2014 usa new jersey metro new york procure proton therapy center p 2012 1168 dec 2014 usa seattle, wa seattle cancer care alliance procure proton therapy center p 20 420 dec 2014 usa st. Establishing costeffective allocation of proton therapy.
They are more effective than h2 receptor antagonists and prokinetic agents in oesophagitis and endoscopy negative reflux disease. The rr proton therapy versus conventional therapy was 0. Proton beam therapy versus photon radiotherapy for adult. The theoretical advantage of pbt is that it produces a more conformal dose distribution due to the bragg peak, with a potentially lower risk of sideeffects in normal tissues and a lower radiationinduced secondary cancer risk in longterm survivors. Methods a cost analysis was conducted from the alberta ministry of health perspective with a 15year horizon. Radiation oncologycosteffectiveness wikibooks, open. It is a relatively straightforward and simple method. It is clear that such protons can penetrate to any part of the body.
Proton beam therapy versus photon radiotherapy for adult and pediatric oncology patients. Cost benefit analysis cba monetary units monetary units quality adjusted life year qaly life years 0 1 utility 4 0,9 3,6 3 0,7 2,1 4 0,2 0,8. Describe considerations when determining if a patient is an eligible candidate for proton therapy, or when photon therapy may be a safer option. Uncertainty surrounding improvements in outcomes limits our ability to estimate cost effectiveness. However, due to improvements in equipment and techniques as well a common interest to design international prospective comparison trials. Big bet on proton therapy for cancer comes amid insurer. Costbenefit analysis involves comparing the values costs and benefits of an activity by assessing the benefits and costs faced by a community with the activity compared to without the activity.
Anita mahajan, md, medical director of the proton therapy center at the university of texas md anderson cancer, said newer technology will help reduce the cost of proton beam therapy facilities. Costeffectiveness particle therapy madelon pijlsjohannesma 1, yolande lievens. Asked for his opinion, a researcher at one of the institutions that does have a proton therapy center, andrew lee, md, associate professor of radiation oncology at the university of texas m. Sensitivity analysis for the patient aged 12 yearsa a for each proton. Cost of new technologies in prostate cancer treatment. Using the grades of recommendation, assessment, development and evaluation approach, the quality of evidence was low for rarp and. Clair et al first described the potential dosimetric benefits of proton csi pcsi in patients with medulloblastoma 5, 6. What conditions make proton beam therapy financially. The costeffectiveness of particle therapy in nonsmall cell lung cancer.
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