Proton beam radiation therapy has been touted as the next big thing in cancer care. The idea, enthusiasts say, is that doctors can deliver higher, more focused doses of radiation than they can in traditional therapy, with a lower risk of side effects. The massive machines, housed in facilities the size of football fields, have been sprouting up across the country for a decade.
There are already 14 proton therapy centers in the U.S., and a dozen more facilities are under construction, even though each can cost $200 million to build.
"I never thought that in my lifetime that I would see a proton center close," says Amitabh Chandra, an economist at Harvard's Kennedy School of Government, who studies the cost of American medical care.
He's surprised because until now, industry growth has been entirely in the other direction, even though there's little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.
"But we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology," Chandra says.
In the Washington, D.C., area alone, three proton therapy centers are under construction. One is at Johns Hopkins Medicine's Sibley Memorial Hospital in D.C. Another is at MedStar Georgetown University Hospital, and a third — the Maryland Proton Treatment Center — is slated to open at the University of Maryland in Baltimore next year.
Officials at all three institutions say they are continuing to build their centers, despite the news out of Bloomington.
But in Indiana, a review committee determined that it just wasn't worth spending the money that would be necessary to update their proton facility. One reason for the closure is that insurers have been refusing to cover the treatment for common diseases, such as prostate cancer and breast cancer. Cigna, for example, only covers proton therapy for a single rare eye cancer, says Dr. David Finley, the group's national medical officer.
"When it's used, however, for all other tumors, it's not been showing to be any more effective than other forms of radiation therapy," says Finley.
Proton beam therapy costs three to six times as much as standard radiation therapy for illnesses like prostate cancer, according to Finley. He adds that when insurers pay for expensive care that isn't any better than the cheaper options, it can increase the cost of everyone's health care.
"We said if two services offer the same result, and one is much more expensive than the other one, we're only going to pay for the one that is less expensive," Finley says.
Other major insurers, including Aetna and Blue Shield of California, have also limited what they'll cover with proton therapy.
But in Washington D.C., the hospitals building new proton therapy centers aren't deterred by these coverage decisions by insurers. In emailed statements, all three hospitals said construction is continuing. Two said that the larger population of Baltimore and the District can support a proton facility more readily than a small city like Bloomington. The third hospital said it is building a smaller, one-room center that will be more cost-effective.
One health care insurer that has not put any restrictions on proton therapy is Medicare. And Medicare pays much more for the treatment than it pays for standard radiation therapy.
"That's the problem with Medicare payment policy," says Harvard's Chandra. "It not only covers treatments that are dubious treatments;it also covers dubious treatments extremely generously."
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