Imagine a prostate cancer therapy that has almost no side effects. Hospitals say it exists and they're vying to be among the first to offer it. Too bad the treatment may not work as well as advertised and could boost America's already spiraling health care costs.
The technology uses narrowly focused proton beams to deliver precisely targeted blasts of radiation. The particle beams are delivered by 500-ton machines in facilities that cost from $100 million to $200 million, and can require a football-field sized building to house. A typical treatment costs about $50,000, twice as much as traditional radiation therapy though it is usually covered by Medicare or private insurance.
For U.S. taxpayers and employers facing spiraling health care costs, that's a worry.
"Proton-beam therapy is like the death star of American medical technology; nothing so big and complicated has ever been confronted by the system," said Amitabh Chandra, a health economist at Harvard University's John F. Kennedy School of Government. "It's a metaphor for all the problems we have in American medicine."
Yet even though the machines are breathtakingly expensive, hospitals and for-profit clinics are in a race to build proton-beam facilities for their prestige, perceived benefits, and potential revenue. One machine can generate as much as $50 million in annual revenue and new facilities are sprouting up around the country.
"It's like a nuclear arms race now, everyone wants one," said Anthony Zietman, a radiation oncologist at Boston's Massachusetts General Hospital, which has had a proton-beam accelerator since 2001.
Proponents of the technology say it can zap cancerous tumors without damage to surrounding tissue. That's a major benefit for the relatively small number of people who suffer from tumors of the spine, brain and eyes, where stray radiation may blind or paralyze, or in children who are more sensitive to radiation.
The therapy has even wider appeal for treating prostate cancer, a much more common disease, since existing treatment often causes rectal bleeding as well as impotence. More than 240,000 American men were diagnosed with prostate cancer in 2011, making it the nation's most-diagnosed tumor, according to the American Cancer Society. Most of those men are potential candidates for proton-beam therapy.
The problem is that despite the push to build proton-beam facilities and the groundswell of enthusiasm for the treatments, it remains unclear whether the therapy does a better job of shrinking tumors or avoiding side effects than the far less costly traditional therapy. Clinical trials haven't yet provided a clear picture proving the treatment's worth for common tumors such as prostate cancer.
So far, 35,000 Americans have gotten proton-beam treatment and reimbursement payments from Medicare and insurance companies amount to only a small fraction of that paid out for traditional radiation therapy.
In 2010, the most recent year for which figures are available, Medicare spent $41.8 million on outpatient proton-therapy treatments, versus $1.06 billion for standard external-beam radiation.
The amount so far reimbursed for proton-beam therapy is small because most of the 10 existing facilities have been open only a short while.
Another 10 facilities are slated to open within the next few years, according to Leonard Arzt, executive director of the National Association for Proton Therapy based in Silver Spring, Md. Dozens more hospitals and medical centers have expressed an interest in developing their own proton-beam facilities.
Some experts are concerned that the proliferation of these centers will put yet another heavy burden on the health care system while providing unclear benefits to most patients. "It is an example of how our health care system is set up to become more expensive without getting necessarily better," said Steven Pearson, president of the Institute for Clinical and Economic Review, a research institute at the Massachusetts General Hospital in Boston.