Summary
PBRT is an exciting technology that has emerged as a life saver for children and many adults with head/neck , eye and other difficult to treat cancers. Proton Centers require massive investments from $100-250 million. Payor groups from Medicare to commercial plans are faced with whether to pay for this promising technology and what diagnoses are appropriate. This study looks at the effectiveness of PBRT vs. IMRT and other current treatment options. But can centers have an ROI on uncommon cancer?
Analysis
The findings of the AHRQ study indicates that while PBRT is a very promising technology for many cancers, insufficient scientific study has taken place to compare its effectiveness with other forms of therapy. Even given PBRT's effectiveness in areas such as uveal melanoma, the question is begged but not answered in the report if PBRT centers can justify their direct investment on the strength of the treatment of less common cancers (those other than lung, breast and prostate).
Considerable marketing investments are being made by PBRT centers to attract patients to the center for treatment for more common, higher volume cancer treatment. Payors are under considerable pressure to include this therapy as an accepted protocol to alleviate the high cost of therapy. Given market pressure, clinical evidence versus the need to closely manage tax & premium dollars, how will Medicare and health plans respond? The study is inconclusive.
I'd be pleased to share personal insights and how many plans are weighing PBRT.
