Since healthcare costs are rising and resources are scarce, it is important to consider the societal impact in addition to the clinical impact of new technologies, such as proton therapy. It is essential for patients and society that scarce resources are spent as efficiently as possible. As proton therapy carries high investment and operational costs, but may also provide high clinical value, a so-called Health Technology Assesment (HTA) is essential.
A HTA includes an economic evaluation to determine the cost- effectiveness of proton therapy compared to photon therapy. Furthermore, HTA also covers the logistical factors, the implication of technological advances and its impact on overall healthcare delivery costs.
Radiation therapy is used in the treatment of cancer to kill cancer cells. The usual radiotherapy with photons works well enough for many patients, but sometimes the tumor is too close to vulnerable organs or is relatively insensitive to the usual radiation. In those cases, proton therapy can be an option.
Proton therapy is a new way to treat cancer. The program focuses on low-grade brain tumor and head and neck cancer. Proton therapy is different from traditionally used photon therapy, as it makes use of very local and precise dose deposition on tumors. This causes less damage to the surrounding normal tissue, resulting in fewer side effects. Proton therapy is a form of radiation that uses protons instead of photons. Protons are small, charged particles that are in the core of an atom. To irradiate a tumor, the protons are accelerated to more than half the speed of light. The proton beam is directed at the tumor. The speed of the protons can be adjusted in the accelerator in a way the protons only destroy the tumor tissue, and surrounding healthy tissue is damaged as little as possible. However, it is more expensive than photon therapy and has high investment costs.
Two types of cancer
In this consortium, an HTA will be performed on proton therapy for the first time. The program initially focuses on two types of cancer. One is the low-grade brain tumor, which grows relatively slowly and often occurs in young people (30-45 years old). The other is head and neck cancer, which grows relatively fast and is more common among elderly people (60-75 years old). Currently, the patients involved in the assessment are being treated at HollandPTC and data collection has started. HollandPTC, founded by Erasmus MC, LUMC and TU Delft, is a treatment center for proton therapy
Including these two different kinds of cancer will give a broad overview of proton therapy for the HTA. This research will lead to a generic model that can be easily adjusted to map the cost-effectiveness and value of proton therapy for all other types of cancer, which will be very useful in the future.
Collaboration between the Erasmus University in Rotterdam, Leiden University and HollandPTC is realized in this program. One researcher will evaluate the cost structure of the proton center as well as the total cost of proton therapy from a societal perspective. Another researcher will be working on determining the value proposition of proton therapy for the two types of cancer, to eventually create a uniform model for decision making and cost- effectiveness analysis of proton therapy.