Proton Therapy May Decrease Overall Costs While Improving Quality of Cancer Care

Steven J. Frank, M.D. Associate Professor of Radiation Oncology Medical Director of the Proton Therapy Center The University of Texas MD Anderson Cancer Interview with:
Steven J. Frank, M.D.
Associate Professor of Radiation Oncology
Medical Director of the Proton Therapy Center
The University of Texas MD Anderson Cancer Center Editor’s Note:

A recent research published in Oncology Payers, discusses the quality of life benefits and cost-savings of intensity modulated proton therapy (IMPT or proton therapy) with traditional x-ray therapy for advanced stage head and neck cancer. The senior author of the paper, Dr. Steven Frank, highlights two oropharyngeal cancer patients, one of whom received proton therapy and the other x-ray treatments. Both patients received chemotherapy.

The study showed that although the upfront costs of proton therapy were three times that of standard x-ray treatments, the proton therapy patient was spared the necessity of a feeding tube, nutritional and supportive care and weight loss that accompanied the x-ray treatments. By the end of the treatment period, the total care costs for the proton therapy patient were 20% lower than the x-ray treatment plan.

To evaluate the costs, Dr. Frank has been employing a costing tool used elsewhere at MD Anderson called Time-driven Activity-based Costing that places the emphasis on the value of medical care, both monetary and in terms of quality of life. Dr. Frank plans to enroll 360 patients over the next five years as well as to open the study to other cancer centers. He notes that the results will be especially valuable as health insurance companies look to further bundled insurance payments.

Dr. Frank was kind enough to answer several questions regarding his work for the audience.

Medical Research: From a patient’s perspective, what are the main differences between traditional x-ray therapy and proton therapy for cancer treatment?

Dr. Frank: In proton therapy, the radiation hits the cancer, while with traditional x-ray the radiation hits the cancer and the normal tissues in the head and neck, causing more side effects during and after treatment. The main advantage is that proton therapy eliminates unnecessary radiation. As radiation oncologists, our primary goal is to effectively kill cancer while sparing the patient the side effects of excessive radiation. Proton therapy achieves this for many patients with a variety of cancers, including lymphoma, lung, head and neck, prostate, esophageal and pediatric cancers.

Medical Research: What are the barriers to wider implementation and acceptance of proton therapy?

Dr. Frank: The main barriers are insurance coverage and lack of access to proton therapy for the majority of patients and radiation oncologists. Further, the upfront expense of the proton machines limits the number of machines currently available.

Medical Research: How would you describe the Time-driven Activity-based Costing model and its role in defining health care value?

Dr. Frank: Time-driven Activity-based Costing uses process maps to define the cost of care for the hospital as the patient undergoes treatment and the overall episodic cost of care. Understanding the costs with process maps allows for additional efficiencies and process improvement to be incorporated thus improving the process and quality of treatment while increasing patient access to the technology. Health care value is enhanced by monitoring and improving outcomes while reducing total costs.

Robert Kaplan, from Harvard Business School, discusses this method of managing a company’s limited resources and has recently begun to apply this methodology to a health care model. His method allows for administrators and providers to look at health care delivery collaboratively to build constructive care with built in efficiencies.

We need to look at the episodic cost of care (all the services related to a particular problem) in order to drive both cost efficiencies and patient/provider satisfaction. For example, if a physician-extender can do an initial patient evaluation, enter history; order laboratory testing etc., the physician may be able to see more patients, decreasing wait times and increasing overall practice revenue and patient satisfaction.

Medical Research: Will this model be useful for other areas of oncology/medicine especially in light of anticipated bundled care payments?

Dr. Frank: Yes. With bundled care payments, the cost-risk is transferred to the hospital system. Understanding and improving the processes and reducing costs will help increase patient access to the technology while maintaining, measuring and improving quality.

Medical Research: What future research do you have planned in this area?

Dr. Frank: We are looking forward to expanding this value-based determination to all patients treated with proton therapy to clarify the value of proton therapy in each disease site.


Defining the Value of Proton Therapy Using Time Driven Activity Based Costing
Frank et al; Oncology Payers, August 2014, pages 26-34


Kaplan, Robert S., Mary L. Witkowski, Larry Higgins, Jon Warner, and Michael Sherman. “How to Design a Bundled Payment around Value.” Leading Health Care Innovation (blog) (October 3, 2013). (New England Journal of Medicine & Harvard Business Review Online Forum.)


Last Updated on March 1, 2015 by Marie Benz MD FAAD