Although plans to build a $235 million proton-beam cancer treatment facility in New York City may sound like a breakthrough in helping to eradicate several forms of the deadly disease, the question is will it be financially worth the effort, or turn put to be too expensive for patients. For example, some insurance companies such as Aetna refuse to cover proton-beam treatment for prostate cancer, which can cost as twice as much as X-ray radiation treatment.
Proton-beam therapy is a more concentrated form of radiation, which fires direct doses to the targeted tumor, and avoids extra spillage of radiation into to surrounding, non-cancerous tissue that can often result in lead to side effects including secondary cancers.
“Our decision was based on the fact that new evidence came out that showed that it wasn't much more effective than the other forms," explained Aetna spokeswoman Tammy Arnold.
According to industry sources, Cigna is reviewing its current policy regarding proton-beam treatment for prostate cancer, while Blue Shield of California is following Aetna’s lead and dropping coverage for early-state prostate cancer next month. It was also noted that insurance companies that do cover the treatment report that they generally end up paying out “anywhere from $20,000-$30,000 for proton therapy, compared to $50,000-$60,000 for the conventional treatment, according to an industry source.” Medicare covers about $32,000 for proton therapy, compared to $19,000 for regular radiation treatments.
"Our clinical focus will be on young adults with brain, head and neck, as well as childhood cancers-all of which are reimbursed by insurers. We have made a conscious effort to consider cost concerns related to this new technology,” stated said Dr. Shalom Kalnicki, chairman of the radiation oncology department at Montefiore Medical Center, part of a the 5-hospital NYPC consortium involved in the project. “This treatment, admittedly, is not appropriate for everyone,"
Proton-beam therapy is less disputed for use in treating cancer in children, and tumors of the head and neck, brain and spinal cord.
In addition to Montefiore, other members of the consortium include Memorial Sloan-Kettering Cancer Center, Mount Sinai Medical Center, New York University Langone Medical Center, and Continuum Health Partners. Once approved, they expect to treat approximately 40 patients a day at the new ProCure facility, which will be housed in its own Manhattan building.
"I certainly think the evidence is there to justify building these centers," advocated Dr. Oren Cahlon, medical director of ProCure, who cited that than a dozen others are currently being built, or are already operational, including ones at St. Jude's Children's Hospital, the Mayo Clinic and Johns Hopkins. "We think the medicine will prove itself."