MD Anderson cost analysis shows proton therapy less costly than IMRT for advanced head/neck cancers

According to research from The Proton Therapy Center at The University of Texas MD Anderson Cancer Center, the episodic cost of care using intensity modulated proton therapy (IMPT) in advanced stage head and neck cancer is less costly than IMRT (x-ray therapy). Published in the inaugural issue of Oncology Payers, this "proof of concept" study uses an innovative cost analysis tool that can be used to define the value of competing healthcare technologies and treatments.

"This study, while focused on a small sample of patients, for the first time confirms empirically what many oncologists and radiologists believe but has not been fully borne out by research," says senior author Steven J. Frank, M.D., medical director of the center and associate professor of radiation oncology. "Even though the upfront cost of proton radiation is higher than IMRT, its ability to minimize side effects ultimately results in fewer healthcare dollars. Also, though the study focused on shorter-term complications, we believe it would apply to long-term. This is critically important for head and neck cancer patients, as they're more likely to be young adults with families and long lives ahead."

The study focused on two oropharyngeal cancer patients during the course of 33 daily radiation doses - one patient receiving IMPT, the most advanced form of proton radiation which can spare surrounding healthy tissue from damage, and the other receiving IMRT, which destroys both cancerous and healthy cells. The patients also had weekly chemotherapy treatments. The researchers found:

• While the daily cost for proton therapy was roughly triple the cost of IMRT, the IMRT patients' outcomes and quality of life measures necessitated additional clinical costs.
• These included moderate to severe toxicity, a required feeding tube, nutritional and other supportive care, and weight loss that necessitated revised radiation plans.
• By the end of the patients' treatments, the proton therapy costs were 20 percent lower than IMRT.

These findings are based on a costing model known as Time-driven Activity-based Costing (TDABC), a tool that relates the measurement of costs to time - such as the time required to perform each individual medical service.[1] The methodology is being explored across numerous areas at MD Anderson Cancer Center under the leadership of Thomas Feeley, M.D., head of the Institute for Cancer Care Innovation and a co-author of this study.

"This is an important first step in shifting a decades-old conversation strictly about the initial costs of proton therapy to a discussion about value," says Dr. Frank. "There is a cost-based incentive to think about the value - monetary and in terms of quality of life - of avoiding some of the complications of cancer treatment in the first place."

Dr. Frank is building on this research with a randomized clinical trial: he has enrolled nearly 50 patients to date and aims to recruit a total of 360 patients over the next five years. He also hopes to open the study to other cancer centers in the near future. Dr. Frank anticipates that ongoing findings from the study will help inform health policy changes underway across the nation, including bundled insurance payment initiatives.