Patient selection and patient referral are pivotal.
In the past centers with 4 or even 5 treatment rooms projected to treat over 2000 patients annually. To achieve half of that counts as a major success — a success that very few centers will achieve.
The overall cost of a proton therapy center has come down considerable since the early days of proton therapy. Revenues are also coming down, however. More and more healthcare insurers want to see more evidence of the clinical benefit proton therapy has over other radiotherapeutic modalities. In several countries they are bringing down their reimbursement rates as well.
Depending on the definition of what constitutes significant clinical benefit, between 5 and 15% of all patients receiving radiotherapeutic treatment for a malignancy qualify for proton therapy. To know how high a percentage is realistic for a given initiative — and then how to identify these patients — is a challenge.
Too many centers are treating patients who will have only a marginal benefit, if any. The so called “model-based approach” as introduced in the Netherlands — using Normal Tissue Complication Probability (NTCP) models to predict the likelihood of reduction of serious side-effects using proton therapy — is a big step forward in this respect. But no matter how you want to do it, getting patient selection right takes an effort.
An effort potential referrers are unlikely and or or unable to make. If a doctor can’t tell for sure whether a patient will benefit from proton therapy, the patient is unlikely to be referred. If external referral is essential to make a success of your proton therapy center (and it usually is) work on reaching out and building a network has to start early.
How many patients are likely to benefit from proton therapy? What are realistic internal referral numbers? How many external referrals are needed? Where might they come from? What are referrers in need of?
Trees with Character can help you to get these questions answered.
If you found this to be of interest perhaps you may want to read the following original contributions: Solutions in proton therapy — for initiatives (a report), Procuring proton therapy equipment (a case) and A Business Case for a proton therapy initiative (a case).
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