Page 33 small repertoire of proton cyclotrons such as IBA and Varian to better develop systems with smaller footprint and cheaper implementation which is a priority in the next generation of models . Many smaller companies are also developing small footprint systems however manufacturing and supply chain demands , along with inferior reputation , makes Varian , IBA and similar companies more attractive for centres looking to adopt PT .
Despite high costs , there is clear value in the implementation of PT systems
Reimbursement potential of $ 7.5m per room for PT Assessing the cost of standard prostate cancer treatment procedures in the US allows us to model the potential reimbursement time-frame for payers implementing systems in context ( Table 17 ). The average annualised drug cost of $ 150,000 equates to c .$ 40m for 250 patients / year . A single-room PT system costs between $ 20m and $ 30m and can treat about 250 patients / year ( 6,250 radiations p . a . equals 25 radiations per patient ). If we assume an investment horizon of 10 years ( depreciation period ) and a cost of $ 25m for a PBT room , the average cost per year is $ 8,000 / patient per year . This would be comparable to the current US reimbursement rate of $ 1,200 per fraction with 25 fractions per patient , which results in a total cost of $ 30,000 / patient / year . 6,250 fractions / machine per year would result in annual reimbursement income of $ 7.5m per year . Including the service charges 7 %, the purchase of a PBT system would break even after five years . Many centres would look to install multiroom systems which may cost upwards of $ 100m , but with capacity to treat more patients , could reach its reimbursement target within a similar time-frame .
Table 17 : Prostate cancer treatment costs in the US , 2015 |
Company |
Product |
Mean Cost |
Radical prostatectomy |
Complete removal of the prostate gland is performed with the use of one of three surgical approaches : radical retropubic prostatectomy , laparoscopic radical prostatectomy , or robot-assisted prostatectomy . The latter |
$ 16,762 |
|
two are less invasive . |
|
Brachytherapy |
Brachytherapy with the use of low-dose-rate isotopes involves permanent implantation of seeds that emit a low dose of radiation over a period of several months . Some patients also receive a boost of external-beam |
$ 17,076 |
|
RT or androgen-deprivation therapy . |
|
IMRT |
Advanced form of three-dimensional RT . Involves use of a computer-driven machine that revolves around the patient as it delivers radiation . Radiation beams are aimed at the prostate from multiple angles . Intensity can be adjusted to maximise the dose targeted at cancerous tissue and minimise the dose to surrounding |
$ 31,574 |
|
healthy tissue . |
|
Androgen-deprivation therapy |
Hormone treatment that reduces the effects of testosterone , thereby slowing the growth of prostate cancer .
Medications are administrated orally or injected to reduce or block circulating androgens .
|
$ 2,112 |
Active surveillance |
Active plan to postpone intervention . Typically involves monitoring with office visits every 6 months , prostate-specific antigen testing , digital rectal examination and prostate biopsy . |
$ 4,228 |
Cryosurgery |
Liquid nitrogen or liquid carbon dioxide is used to freeze tissue in order to destroy abnormal cells . |
- |
Stereotactic body radiation therapy
External-beam RT as a threedimensional conformal treatment
Source : goetzpartners Research , NEJM 2015
Type of external-beam radiation therapy . Involves the use of special equipment to position a patient and precisely deliver radiation to tumours in the body ( except the brain ). The total dose of radiation is divided into smaller doses given over a period of several days . Helps spare normal tissue . Also called three-dimensional RT and three-dimensional conformal RT . Procedure uses a computer to create a three-dimensional picture of the tumour , allowing doctors to give the highest possible dose of radiation to the tumour , while sparing as much of the normal tissue as possible .
-
$ 20,588
Table 18 : Comparison for US cancer treatment costs |
Cost |
Modern therapy – immune therapy (+) |
Standard therapy – chemotherapy (*) |
Modern therapy –
PT
|
Standard therapy –
IMRT
|
Material cost ( 1 ) |
$ 90,000 |
$ 1,200 |
$ 8,000 |
$ 2,800 |
Service cost ( 2 ) |
- |
- |
$ 5,600 |
$ 980 |
Treatment ( 3 ) |
$ 2,800 |
$ 2,800 |
$ 2,800 |
$ 2,800 |
Hospital stay |
$ 10,000 |
$ 10,000 |
$ 7,500 |
$ 7,500 |
Total cost |
$ 102,800 |
$ 14,000 |
$ 23,900 |
$ 14,800 |
Reimbursement |
$ 113,080 |
$ 15,000 |
$ 40,000 |
$ 35,761 |
Source : goetzpartners Research , DIRAC
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