Radiotherapy & Oncology
Volume 95, Issue 1 , Pages 45-53 , April 2010

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

  • Andrea Peeters

      Affiliations

    • Maastricht Radiation Oncology (MAASTRO Clinic), The Netherlands
    • Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands
    • ,
  • Janneke P.C. Grutters

      Affiliations

    • Maastricht Radiation Oncology (MAASTRO Clinic), The Netherlands
    • Department of Health Organization, Policy & Economics, Maastricht University, The Netherlands
    • ,
  • Madelon Pijls-Johannesma

      Affiliations

    • Maastricht Radiation Oncology (MAASTRO Clinic), The Netherlands
    • GROW Research Institute, University Medical Center, Maastricht, The Netherlands
    • Corresponding Author InformationCorresponding author. Address: Maastricht Radiation Oncology (MAASTRO Clinic), Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands.
    • ,
  • Stefan Reimoser

      Affiliations

    • Turner & Townsend, München, Germany
    • ,
  • Dirk De Ruysscher

      Affiliations

    • Maastricht Radiation Oncology (MAASTRO Clinic), The Netherlands
    • GROW Research Institute, University Medical Center, Maastricht, The Netherlands
    • ,
  • Johan L. Severens

      Affiliations

    • Department of Health Organization, Policy & Economics, Maastricht University, The Netherlands
    • Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands
    • ,
  • Manuela A. Joore

      Affiliations

    • Department of Health Organization, Policy & Economics, Maastricht University, The Netherlands
    • Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands
    • These authors contributed equally to this work.
    • ,
  • Philippe Lambin

      Affiliations

    • Maastricht Radiation Oncology (MAASTRO Clinic), The Netherlands
    • GROW Research Institute, University Medical Center, Maastricht, The Netherlands
    • These authors contributed equally to this work.

Received 18 December 2008 ,Revised 8 December 2009 ,Accepted 17 December 2009.

References 

  1. Schulz-Ertner D, Jakel O, Schlegel W. Radiation therapy with charged particles. Semin Radiat Oncol. 2006;16:249–259
  2. Lievens Y, Van den Bogaert W. Proton beam therapy: too expensive to become true?. Radiother Oncol. 2005;75:131–133
  3. Goitein M, Jermann M. The relative costs of proton and X-ray radiation therapy. Clin Oncol (R Coll Radiol). 2003;15:S37–S50
  4. Schulz-Ertner D, Tsujii H. Particle radiation therapy using proton and heavier ion beams. J Clin Oncol. 2007;25:953–964
  5. Schulz RJ, Smith AR, Orton CG. Point/counterpoint. Proton therapy is too expensive for the minimal potential improvements in outcome claimed. Med Phys. 2007;34:1135–1138
  6. Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. 3rd ed.. Oxford: Oxford University Press; 2005;
  7. Brada M, Pijls-Johannesma M, De Ruysscher D. Proton therapy in clinical practice: current clinical evidence. J Clin Oncol. 2007;25:965–970
  8. Greco C, Wolden S. Current status of radiotherapy with proton and light ion beams. Cancer. 2007;109:1227–1238
  9. Lodge M, Pijls-Johannesma M, Stirk L, Munro AJ, De Ruysscher D, Jefferson T. A systematic literature review of the clinical and cost-effectiveness of hadron therapy in cancer. Radiother Oncol. 2007;83:110–122
  10. Olsen DR, Bruland OS, Frykholm G, Norderhaug IN. Proton therapy – A systematic review of clinical effectiveness. Radiother Oncol. 2007;83:123–132
  11. Halperin EC. Overpriced technology in radiation oncology. Int J Radiat Oncol Biol Phys. 2000;48:917–918
  12. Zietman AL. The Titanic and the Iceberg: prostate proton therapy and health care economics. J Clin Oncol. 2007;25:3565–3566
  13. Pijls-Johannesma M, Pommier P, Lievens Y. Cost-effectiveness of particle therapy: current evidence and future needs. Radiother Oncol. 2008;89:127–134
  14. Jakel O, Land B, Combs SE, Schulz-Ertner D, Debus J. On the cost-effectiveness of carbon ion radiation therapy for skull base chordoma. Radiother Oncol. 2007;83:133–138
  15. Konski A, Speier W, Hanlon A, Beck JR, Pollack A. Is proton beam therapy cost effective in the treatment of adenocarcinoma of the prostate?. J Clin Oncol. 2007;25:3603–3608
  16. Lundkvist J, Ekman M, Ericsson SR, Jonsson B, Glimelius B. Proton therapy of cancer: potential clinical advantages and cost-effectiveness. Acta Oncol. 2005;44:850–861
  17. Huybrechts M, Obyn C, Gailly J, Mambourg F, Vinck I, Ramaekers D. Hadrontherapy. Health Technology Assessment (HTA), Brussels: Federaal Keniscentrum voor de Gezondheidszorg (KCE). KCE reports 67A. 2007.
  18. Perrier L, Combs S, Auberger T, et al. A decision-making tool for a costly innovative technology: the case of carbon ion radiotherapy. J Econ Med. 2007;25:367–380
  19. Lambin P, Fekkers H, Daniels E, et al. Euregional ion therapy institute. Maastricht: Business Plan; 2005.
  20. Slotman BJ, Leer JW. Infrastructure of radiotherapy in The Netherlands: evaluation of prognoses and introduction of a new model for determining the needs. Radiother Oncol. 2003;66:345–349
  21. Oostenbrink JB, Bouwmans CAM, Koopmanschap MA, Rutten FFH. Manual for costing research. Amstelveen, The Netherlands: College voor zorgverzekeringen (Health Care Insurance Board); 2004;
  22. Tsujii H, Mizoe J, Kamada T, et al. Clinical results of carbon ion radiotherapy at NIRS. J Radiat Res (Tokyo). 2007;48:A1–A13
  23. Nguyen PL, Zietman AL. High-dose external beam radiation for localized prostate cancer: current status and future challenges. Cancer J. 2007;13:295–301
  24. Zietman AL, DeSilvio ML, Slater JD, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA. 2005;294:1233–1239
  25. Slater JD, Rossi CJ, Yonemoto LT, et al. Proton therapy for prostate cancer: the Initial Loma Linda University experience. Int J Radiat Oncol Biol Phys. 2004;59:348–352
  26. Peeters ST, Heemsbergen WD, Koper PC, et al. Dose–response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24:1990–1996
  27. Zelefsky MJ, Fuks Z, Leibel SA. Intensity-modulated radiation therapy for prostate cancer. Semin Radiat Oncol. 2002;12:229–237
  28. Leibel SA, Fuks Z, Zelefsky MJ, et al. Intensity-modulated radiotherapy. Cancer J. 2002;8:164–176
  29. Leborgne F, Fowler J. Late outcomes following hypofractionated conformal radiotherapy vs. standard fractionation for localized prostate cancer: a nonrandomized contemporary comparison. Int J Radiat Oncol Biol Phys. 2009;74:1441–1446
  30. Shipley WU, Thames HD, Sandler HM, et al. Radiation therapy for clinically localized prostate cancer: a multi-institutional pooled analysis. JAMA. 1999;281:1598–1604
  31. Miyamoto T, Baba M, Sugane T, et al. Carbon ion radiotherapy for stage I non-small cell lung cancer using a regimen of four fractions during 1 week. J Thorac Oncol. 2007;2:916–926
  32. Bush DA, Slater JD, Shin BB, Cheek G, Miller DW, Slater JM. Hypofractionated proton beam radiotherapy for stage I lung cancer. Chest. 2004;126:1198–1203
  33. Hata M, Tokuuye K, Kagei K, et al. Hypofractionated high-dose proton beam therapy for stage I non-small-cell lung cancer: preliminary results of a phase I/II clinical study. Int J Radiat Oncol Biol Phys. 2007;68:786–793
  34. Lagerwaard FJ, Haasbeek CJ, Smit EF, Slotman BJ, Senan S. Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2008;70:685–692
  35. Lagerwaard FJ, Senan S, van Meerbeeck JP, Graveland WJ. Has 3-D conformal radiotherapy (3D CRT) improved the local tumour control for stage I non-small cell lung cancer?. Radiother Oncol. 2002;63:151–157
  36. Mizoe JE, Tsujii H, Kamada T, et al. Dose escalation study of carbon ion radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2004;60:358–364
  37. Orecchia R, Zurlo A, Loasses A, et al. Particle beam therapy (hadrontherapy): basis for interest and clinical experience. Eur J Cancer. 1998;34:459–468
  38. Laramore GE. Role of particle radiotherapy in the management of head and neck cancer. Curr Opin Oncol. 2009;21:224–231
  39. Jereczek-Fossa BA, Krengli M, Orecchia R. Particle beam radiotherapy for head and neck tumors: radiobiological basis and clinical experience. Head Neck. 2006;28:750–760
  40. Rades D, Fehlauer F, Wroblesky J, Albers D, Schild SE, Schmidt R. Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy, or conventional radiotherapy. Oral Oncol. 2007;43:535–543
  41. Kwong DL, Pow EH, Sham JS, et al. Intensity-modulated radiotherapy for early-stage nasopharyngeal carcinoma: a prospective study on disease control and preservation of salivary function. Cancer. 2004;101:1584–1593
  42. Garden AS, Morrison WH, Wong PF, et al. Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2007;67:438–444
  43. Chao KS, Majhail N, Huang CJ, et al. Intensity-modulated radiation therapy reduces late salivary toxicity without compromising tumor control in patients with oropharyngeal carcinoma: a comparison with conventional techniques. Radiother Oncol. 2001;61:275–280
  44. Kam MK, Teo PM, Chau RM, et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys. 2004;60:1440–1450
  45. Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W. Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol. 2008;9:367–375
  46. Protocol of National Institute of Radiological Sciences, Chiba, Japan (NIRS). <http://www.nirs.go.jp/ENG/publications/pdf/radiological.pdf>.
  47. Schulz-Ertner D, Karger CP, Feuerhake A, et al. Effectiveness of carbon ion radiotherapy in the treatment of skull-base chordomas. Int J Radiat Oncol Biol Phys. 2007;68:449–457
  48. Hug EB, Sweeney RA, Nurre PM, Holloway KC, Slater JD, Munzenrider JE. Proton radiotherapy in management of pediatric base of skull tumors. Int J Radiat Oncol Biol Phys. 2002;52:1017–1024
  49. Munzenrider JE, Liebsch NJ. Proton therapy for tumors of the skull base. Strahlenther Onkol. 1999;175:57–63
  50. Noël G, Habrand JL, Jauffret E, et al. Radiation therapy for chordoma and chondrosarcoma of the skull base and the cervical spine. Prognostic factors and patterns of failure. Strahlenther Onkol. 2003;179:241–248
  51. Debus J, Schulz-Ertner D, Schad L, et al. Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys. 2000;47:591–596
  52. Player S. Activity-based analyses lead to better decision making. Health Care Financ Manage. 1998;52:66–70
  53. Bonastre J, Noel E, Chevalier J, et al. Implications of learning effects for hospital costs of new health technologies: the case of intensity modulated radiation therapy. Int J Technol Assess Health Care. 2007;23:248–254
  54. Gardner BG, Zietman AL, Shipley WU, Skowronski UE, McManus P. Late normal tissue sequelae in the second decade after high dose radiation therapy with combined photons and conformal protons for locally advanced prostate cancer. J Urol. 2002;167:123–126
  55. Ploquin NP, Dunscombe PB. The cost of radiation therapy. Radiother Oncol. 2008;86:217–223

PII: S0167-8140(09)00660-4

doi: 10.1016/j.radonc.2009.12.002

Radiotherapy & Oncology
Volume 95, Issue 1 , Pages 45-53 , April 2010

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