Costs of Proton Therapy During the Start-up Phase Using Time-Driven Activity-Based Costing in the Netherlands

OBJECTIVES:

Proton beam therapy (PBT) aims to deliver precise treatment compared with conventional radiotherapy for patients with cancer. While this innovation entails investment costs, information about the treatment costs per patient, especially during the start-up phase, is limited. This study aims to calculate the costs for PBT at a single center in the Netherlands during the start-up phase.

METHODS: The cost of a PBT course was estimated for the treatment indications head and neck cancer, breast cancer, brain cancer, thorax cancer, chordoma and eye melanoma. A time-driven activity-based costing analysis was conducted in a newly established proton center in the Netherlands (HollandPTC). Additionally, a scenario analysis was conducted for short-term (2021), middle-term (till 2024) and long-term (after 2024) projections of patient numbers in Holland PTC.

RESULTS:

The cost of PBT in 2020 at HollandPTC varied between €12,062 for an eye melanoma course and €89,716for a head and neck course. Overall, indirect costs, including the operating/interest costs, indirect human resource costs and depreciation costs, were the largest cost component. Consequently, alternative methods to assign these indirect costs over tumor types had substantial impact. By distributing indirect costs according to gantry size, instead of fractions, the treatment cost for head and neck cancer decreased with 45% (from 89,716 to 49,452). Notably, the high indirect costs implied the potential of scale of economics. According to our estimation, the treatment cost could reduce to 35% of the current cost when maximum treatment capacity, given current treatment standards, is achieved.

CONCLUSIONS: This study estimated the proton therapy cost delivered in a newly operated treatment center. Scenario analysis for increased patient numbers revealed the potential for the cost reductions. Still, to have an estimation that reflects the cost for proton therapy in long run that could be used in cost-effectiveness analysis, a follow-up study measuring the stable-operated situation is recommended.