stethoscope on top of billing statement for cost of proton therapy

Cost of Proton Therapy: The Truth Behind The Numbers

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With the cost of cancer treatment making constant headlines and hundreds of million of dollars being invested into new proton therapy centers around the world, it’s tempting to believe some experts who tout the proton therapy as the latest contributor to healthcare’s skyrocketing costs.

That’s just not true. It’s easy to look at the cost of some proton therapy centers being built and assume because it’s so much more expensive to set up than traditional radiation that it is directly reflected in the cost to the patient. However, that’s not exactly the way it works.

How Rates Are Set

The majority of proton therapy centers are freestanding, rather than connected to medical centers. Medicare sets the rate it will pay for the service, including the facility, equipment, personnel costs, supplies, geographic location, insurance, and other direct and indirect expenses. It is not based solely on the price tag of the center and equipment. Private insurance companies individually negotiate with providers like Provision based on the rates Medicare sets for that facility.

Additionally, many of the centers receive significant philanthropic gifts to support the construction of the facility and purchase of the equipment. The Mayo Clinic, for example, received more than $100 million to support its new proton facility. This substantially reduces the cost to develop a proton therapy center.

Newer Tech Reduces Cost of Proton Therapy

And while, initially, proton therapy was more expensive than traditional radiation, newer methods of delivering protons have reduced the number of treatments required and, thus, the cost of service.

Hypfractionation is a method where patients are treated patients with the same prescribed dose of radiation, but only using one-third or two-thirds the amount of treatments. Because of proton therapy’s ability to precisely target tumors with limited exposure to surrounding tissues, there are fewer side effects with treatment, which make it the ideal modality for hypofractionation.

For example, a study at MD Anderson Cancer Center showed a hypofractionated protocol for breast cancer cost $13,833, compared to the $19,599 cost of traditional radiation. Medicare reimbursement rates for hypofractionated treatment of prostate cancer show the cost of proton therapy at $26,050, with the cost of traditional radiation at a comparable $24,420. At Provision, prostate patients who choose hypfractionation could potentially cut their number of treatments from 39 down to 20.

Long-Term Cost Savings

Additionally, while it’s harder to quantify, there are likely long-term cost savings from proton therapy’s reduced size effects and reduced radiation exposure.

For head and neck cancers, proton therapy reduces patient weight loss and the need for feeding tubes—factors that dramatically reduce the gap between proton and x-ray therapy, particularly toward the end of treatment.

Proton therapy reduces the risk of pneumonitis, esophagitis, heart disease, and secondary cancers due to radiation exposure for lung cancer patients.

Recent studies show women treated for breast cancer using traditional radiation receive damaging doses to the heart and lungs.

And let’s not forget that pediatric patients see a long list of physical and neurological benefits from proton therapy.

Another MD Anderson study compared the cost of proton therapy and radiation in the case of patients with head and neck cancer. It concluded that proton therapy was only 6% more expensive than intensity-modulated radiation therapy, after taking into account the healthcare costs associated with weight loss, feeding tube placement, and resulting treatment re-planning and re-simulation because of more side effects associated with IMRT.

This impact on a patient’s life after cancer is known as “quality-adjusted life years,” something that’s inherently hard to calculate. After all, it’s difficult to put a price on improving someone’s quality of life. It’s not an exact science and often varies in the eye of the beholder. From the outside looking in, it can be easy to minimize having a feeding tube placed into your abdomen. But things look a lot different when you’re the one having the procedure performed.

And yet, people – and their health insurance companies – are willing to pay for much costlier chemotherapy treatments to prolong life, if only for a few weeks or months. For example, a drug for metastatic prostate cancer touted its ability to extend life on average by four months. The cost: $90,000.

That’s potentially double the cost, or even more, than most proton therapy cases. Yet, this drug receives robust coverage from most commercial insurance payers, even though it is not even used to cure the cancer.

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For more information about the cost of proton therapy, visit our Insurance Coverage FAQs.