What Conditions Make Proton Beam Therapy Financially Viable in Western Canada?

Wendy L Smith,Sarah Quirk,S Patel,David D Eisenstat,Ivo A Olivotto,Craig D Smith,Marc Mackenzie

doi:10.7759/cureus.3644

Abstract

BackgroundProton beam therapy (PBT) is available in many western and Asian countries, but there is no clinical, gantry-based PBT facility in Canada.MethodsA cost analysis was conducted from the Alberta Ministry of Health perspective with a 15-year horizon. Estimated costs were: PBT unit, facility development as part of an ongoing capital project, electricity, maintenance contract, and staffing. Revenues were: savings from stopping USA referrals, avoiding the costs of standard radiation therapy (RT) for Albertans receiving PBT instead, and cost-recovery charges for out-of-province patients.ResultsThe Ministry of Health funded 15 Albertans for PBT in the USA in the 2014/15 fiscal year (mean CAD$ 237,348/patient). A single-vault, compact PBT unit operating 10 hours/day could treat 250 patients annually. A 100 Albertans, with accepted indications, such as the curative-intent treatment of chordomas, ocular melanomas, and selected pediatric cancers, would likely benefit annually from PBT’s improved conformality and/or reduced integral dose compared to RT. The estimated capital cost was $40 million for a single beamline built within an ongoing capital project. Operating costs were $4.8 million/year at capacity. With 50% capacity reserved for non-Albertans at a cost recovery of $45,000/patient, a Western Canadian PBT facility would achieve net positive cash flow by year eight of clinical operations, assuming Alberta-to-USA referrals reach 21 patients/year by 2024 and increase at 3%/year thereafter. Sensitivity analysis indicates the lifetime net savings is robust to the assumptions made.ConclusionThis business case, based on Canadian costing data and estimates, demonstrates the potential for a financially viable PBT facility in Western Canada.

Highlights

Proton beam therapy (PBT) is a specialized form of radiation therapy (RT)
A 100 Albertans, with accepted indications, such as the curative-intent treatment of chordomas, ocular melanomas, and selected pediatric cancers, would likely benefit annually from PBT’s improved conformality and/or reduced integral dose compared to RT
With 50% capacity reserved for non-Albertans at a cost recovery of $45,000/patient, a Western Canadian PBT facility would achieve net positive cash flow by year eight of clinical operations, assuming Alberta-to-USA referrals reach 21 patients/year by 2024 and increase at 3%/year thereafter

Summary

Introduction

Proton beam therapy (PBT) is a specialized form of radiation therapy (RT). Considerable debate surrounds the appropriate use of PBT in cancer treatment, due to the paucity of outcome studies and randomized trial data, but most experts agree that PBT is clinically justified in select cancer patients [1,2,3,4,5]. PBT is available in all other G7 countries and many Asian countries, but Canada does not have a clinical, gantry-based PBT facility [6]. The group of patients for which the use of protons has been well accepted is termed ‘Category A’ in the American Society for Therapeutic Radiology and Oncology (ASTRO) model policy [1]. Proton beam therapy (PBT) is available in many western and Asian countries, but there is no clinical, gantry-based PBT facility in Canada

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