OBJECTIVES: For non-small cell lung cancer (NSCLC), proton radiotherapy (PT) may provide superior clinical benefit compared with photon radiotherapy (XRT) but is also more costly. Information regarding costs (and comparisons thereof) of PT and XRT is limited, particularly from a societal perspective. Hence, this study aimed to perform a cost analysis of PT versus XRT for the treatment of NSCLC in a combined radiotherapy centre in the Netherlands.

METHODS: The Dutch Cost Guide was followed to estimate costs from first referral to end of treatment for PT and XRT. Costs were calculated probabilistically using Monte Carlo simulations (10,000 iterations) and separated into three categories: healthcare costs, patient/family costs, and productivity losses. Direct healthcare personnel costs were estimated using a time-driven activity-based costing approach, allowing for planning costs to be incorporated independently from number of fractions (20 and 30 fraction schedules). The impact of taking a healthcare perspective and reduced PT fractionation time were explored in scenario analyses.

RESULTS: Treatment planning and preparation costs per patient were €2,075 for PT and €1,985 for XRT. For 20 fraction schedules (societal perspective (healthcare perspective)), costs per fraction were €1,637 (€812) for PT and €687 (€126) for XRT giving total treatment costs of €34,821 (€18,308) for PT and €15,722 (€4,497) for XRT. For 30 fraction schedules, costs per fraction were €1,362 (€811) for PT and €499 (€125) for XRT giving total treatment costs of €42,923 (€18,297) for PT and €16,963 (€4,487) for XRT. The greatest incremental cost driver for PT versus XRT was non-personnel healthcare costs (equipment, buildings, overheads). Reducing PT fractionation time reduced cost disparities by 49-54%.

CONCLUSIONS: Through a detailed micro-costing approach, this cost analysis highlights cost disparities between PT and XRT treatment modalities and serves to inform future cost-effectiveness analyses. Scenario analyses reveal the potential for narrowing cost differences through reducing PT fractionation time.