The cost-effectiveness of particle therapy in non-small cell lung cancer: exploring decision uncertainty and areas for future research.

PURPOSE: To review and synthesize all available evidence in order to explore the cost-effectiveness of particle therapy (carbon-ions, protons) compared to the best current treatments for non-small-cell lung cancer (NSCLC), and the value of additional research. The present study focuses on stage I NSCLC, as no data is available for more advanced stages. METHODS: A probabilistic decision-analytic Markov model was constructed to synthesize all available evidence. Comparative treatments were carbon-ions, protons, conventional radiotherapy (CRT) and stereotactic radiotherapy (SBRT) for inoperable stage I NSCLC; and carbon-ions and SBRT for operable stage I NSCLC. The expected value of perfect information (EVPI) was calculated to support research decisions. RESULTS: For inoperable stage I NSCLC, carbon-ion therapy costed euro 67.257 per quality-adjusted-life-year gained compared to SBRT. Both treatments dominated protons and CRT. Considerable uncertainty surrounded these results, resulting in a high EVPI. For operable stage I NSCLC SBRT dominated carbon-ion therapy. CONCLUSIONS: Due to the considerable uncertainty in stage I NSCLC, and the lack of data on more advanced stages, it is recommended not to adopt particle therapy as standard treatment in NSCLC yet. More evidence is needed to reduce the decision uncertainty and to support evidence-based treatment decisions. It might be worthwhile to invest in a particle facility for clinical research. Future research should also weigh the investment risk, value of information and costs of delay.

How costly is particle therapy? Cost analysis of external beam radiotherapy with carbon-ions, protons and photons.

PURPOSE: Particle therapy has potentially a better therapeutic ratio than photon therapy. However, investment costs are much higher. This study provides an estimation and comparison of the costs of these therapies. METHODS: Within an extensive analytical framework capital and operational costs, cost per fraction, and four tumor specific treatment costs are calculated for three facilities: combined carbon-ion/proton, proton-only, and photon. RESULTS: Capital costs for the combined, proton-only and photon facilities are: euro 138.6 million, euro 94.9 million, euro 23.4 million. Total costs per year are: euro 36.7 million, euro 24.9 million, euro 9.6 million. Cost per fraction is: euro 1128 (euro 877-1974), euro 743 (euro 578-1300), euro 233 (euro 190-407). Cost ratio particle/photon therapy is 4.8 for the combined and 3.2 for the proton-only facility. Particle treatment costs vary from euro 10,030 (c-ion: lung cancer) to euro 39,610 (proton: head & neck tumors). Cost difference between particle and photon therapies is relatively small for lung and prostate cancer, larger for skull-base chordoma and head & neck tumors. CONCLUSION: Investment costs are highest for the combined carbon-ion/proton facility and lowest for the photon facility. Cost differences become smaller when total costs per year and specific treatment costs are compared. Lower fractionation schedule of particle therapy might further reduce its costs.

Integration brings all-round benefits.

Integration of workflow, technology and architecture provides the means to enable hospital staff not only work smarter and more efficiently but also to enjoy their work experience. Patients also benefit from a planned proven outcome in a more ergonomic and pleasant environment--all of which will improve their overall healthcare experience. A process-based approach mirrors the philosophy of a Treatment Centre and we believe that it is a must within an environment of growing complexity that demands faster and improved services--all to be managed with minimal risk. Siemens structures its business according to this approach and is dedicated to helping healthcare providers around the world to improve their performance by enabling truly synchronised workflow throughout the entire healthcare enterprise. We see the massive opportunities for radical efficiency gains in our day-to-day work--all it needs is an early-phase integration of workflow, technology and the physical environment.