Mayo Clinic‘s decision to build two costly proton beam cancer treatment centers is contributing to America’s medical arms race and is “exhibit A” of “what is wrong with American healthcare today,” according to a New York Times editorial by two prominent healthcare thought leaders.
The problem with proton therapy is simple, according to the editorial: It’s very expensive, and it’s only proven to work better than conventional methods in treating a few rare types of pediatric cancer. But because proton facilities are so expensive, often costing close to $200 million, builders are motivated to use proton therapy to treat a wide variety of cancers.
The consequence is that proton therapy ends up costing the U.S. additional millions if not billions in spending each year to treat diseases that could possibly be better treated — and certainly could be more cheaply treated — with other types of therapy.
That is “crazy medicine and unsustainable public policy,” write the authors, oncologist and former White House adviser Ezekial Emanuel; and Steven Pearson, director Institute for Clinical and Economic Review at the Massachusetts General Hospital’s Institute for Technology Assessment.
Like more conventional cancer treatment methods, proton therapy uses radiation. The difference is that protons do the bulk of their work beneath the skin where a tumor is located, unlike X-rays, which tend to lose power and cause collateral damage as they penetrate the body’s tissues. In theory, that means proton therapy allows for the more precise targeting of tumors, reducing collateral damage.
But Emanuel and Pearson aren’t buying into proton therapy’s promise. “The higher price would be worth it if proton beam therapy cured more people or significantly reduced side effects,” they write. “But there is no evidence showing that this is true, except for a handful of rare pediatric cancers.”
Similarly, patient safety group the ECRI Institute last year concluded that no true analysis of the efficacy of proton therapy was possible given that the data available was insufficient. Until that changes, opponents of proton therapy — and there are plenty — will always have ammunition.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Mayo in 2010 announced plans for two $180 million proton centers in Arizona and Minnesota, touting the technology and characterizing the centers as a “bold move forward” for the health system.
Emanuel and Pearson see Mayo’s move fueled by slightly less-idealistic motivations: boosting profits and keeping up with the Joneses, noting that other premier national health systems like M. D. Anderson in Texas and the University of Pennsylvania already have proton centers. There are nine operating proton centers in the U.S., with plenty more on the drawing board.
Still, proton therapy has plenty of staunch advocates. Many who have undergone proton therapy swear by it, saying it provided the hope of a cure without the pain and side-effects associated with X-ray treatment. One support group of prostate cancer patients who’ve undergone proton therapy boasts about 6,000 members and is dedicated to spreading awareness of the treatment option.
So this isn’t an argument that will die anytime soon.
In the meantime, Emanuel and Pearson have a suggestion that could reduce the amount Medicare spends on proton therapy that they call “dynamic pricing.”
Medicare would pay more for proton beam therapy, but only for diseases that are proven to be treated more effectively by the therapy than by other forms of radiation. For cancers like prostate, it would pay only what it pays for the cheaper alternatives. But if studies were done showing that proton beam therapy was better than other treatments, the payment would go up. If no studies were done, or the new evidence demonstrated no advantages, then coverage would continue, but at the lower reimbursement.
Photo from flickr user habi
