by
Gus Iversen, Editor in Chief | October 07, 2015
From the October 2015 issue of HealthCare Business News magazine
For treating head and neck cancer, new research out of MD Anderson outlines the economic value of reducing side effects. It found that when treating with proton therapy only 20 percent of patients required a feeding tube, versus 65 percent with IMRT. The direct cost of using a feeding tube for over a year was estimated to be $31,000 per patient, in 2001. Assuming the cost of those tubes has not changed since then, almost $1.4 million could be saved for every 100 head and neck cancer patients, from feeding tube expenses avoided with proton therapy.
For Frank, those kinds of statistics are essential to helping people realize the full potential of superior care. “As the novel approaches and technologies are proven to be safe and effective, competition in advanced technology such as proton therapy will generate a smaller footprint, become less expensive to manufacture and provide greater access to benefit the larger population,” he says.
Last year the American Society of Radiation Oncology (ASTRO) issued a model insurance policy to help insurance companies figure out which cancer diagnoses meet evidence-based standards for proton treatment and warrant coverage. For prostate, ASTRO supports insuring patients treated in clinical trials or within prospective registries, so their outcomes can help establish the body of evidence.
While Medicare covers proton therapy for most indications, it has sometimes been a battle with private insurers. “Over the last two years, several of the large commercial insurers have stopped covering prostate cancer because they feel they can get the same outcome in terms of ‘cure’ without having to pay as much,” says Rossi.
One example of this was when a patient in Texas with aggressive prostate cancer, complicated by insulin-dependent Type 2 diabetes, was refused coverage from Aetna despite doctor’s recommendations. The ordeal went to court and the insurance company was recently made to cover the treatment.
The patient’s lawyer,
Robert C. Hilliard, issued a statement after the ruling. “This is not some unknown experimental treatment. It works. And my client should be given the opportunity to have the treatment to save his life.” That sentiment, echoed by the parents of Ashya King, perhaps best explains the rapid growth of proton therapy.
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