by
Brendon Nafziger, DOTmed News Associate Editor | May 01, 2011
From the May 2011 issue of HealthCare Business News magazine
This news could put the crunch on centers if CMS increase its scrutiny of expenses and goes through with its vows to promote comparative effectiveness research – tying reimbursement changes to solid evidence that one treatment is better and more cost-effective than another.
“I would say that’s an issue the proton community is dealing with, and there will be, they will have to do more clinical studies,” Leonard Arzt, executive director of the NAPT, told DOTmed News.
But some observers think the evidence for its superiority to other forms of radiation therapy could be hard to obtain, as the effects, while real, could be too small to show up on studies because of limitations on sample size. A 2010 article co-written by Tepper in the Journal of Clinical Oncology, “Technology Evolution: Is It Survival of the Fittest?” suggested that whatever benefits could be had by proton therapy might apply only to “very limited subpopulations” and that the benefits could be “too small to be quantifiable, even in randomized clinical trials with realistic numbers of patients.”
Small after all?
Whatever the case, proton therapy backers note that even if CMS pays more for proton therapy treatment, ultimately, the payments are small fry when looking at U.S. health care expenses as a whole. They’re even small when looking at just the overall Medicare radiation therapy budget.
In response to Paul Levy’s blog post last year, which worried that the proton industry was the sign of the clout of the “health care-financial complex,” the NAPT said even if there were 15 centers treating at full capacity, “they would only be able to treat 1-2 percent of the entire radiotherapy population in the country. That's hardly a blip on the total health care landscape.” In other words, for all its huge size and expense – 1,800 concrete trucks! the size of a football field!– proton therapy is relatively modest, the argument goes. After all, proton proponents reason, what is a $200 million center against the $2.3 trillion spent yearly on U.S. health care?
The makers of the newer, smaller systems are, of course, optimistic, as they have to be. “Short of a complete government takeover of our health care system,” ProTom’s Spotts said, “I believe proton therapy systems will continue to grow.”
EXTRA:
8 out of 9 proton therapy centers prefer…
Cyclotrons and synchrotrons are both types of particle accelerators that use powerful magnetic fields to speed up protons. The cyclotron uses constantly applied magnetic and electric fields to move the proton in a spiral, while the synchrotron increases the strength of the magnetic field to match the change in particle energy (that is, they are “synchronized”). Except for a Hitachi-made synchrotron at M.D. Anderson in Texas, the other eight working proton therapy centers in the U.S. run cyclotrons built by Belgian manufacturer Ion Beam Applications S.A.
Two years to build
Actually building cyclotrons takes a long time, too. IBA, the leading U.S. provider of cyclotrons, says it takes around 16-24 months to build one because of the difficulties in sourcing high-quality steel. IBA hopes they can shake this down to only 12 months for their Proteus One (the smaller footprint, single-room cyclotron), but this device is not commercially available yet. (A prototype was sold to a group in eastern France. The first patient will probably be treated in 2013.) IBA estimates it currently has a backlog of $270 million euros worth of equipment. Varian Medical Systems, which recently got into the proton therapy game after buying a German company a few years ago, said it has five cyclotrons under construction in Europe. But it’s looking to open a U.S. plant to build cyclotrons faster.
Back to HCB News
