OnCo
ideasIdea

Pooled coverage-with-evidence for proton therapy across all centres

Proton therapy costs far more than standard radiotherapy and, for most adult cancers, nobody knows whether it is better. Payers would cover it only inside trials or registries that answer that question, across every centre at once.

National payers and proton centres agree that reimbursement for adult indications without established benefit is conditional on enrolment in pragmatic randomised trials (proton versus photon) or, where randomisation is unacceptable, in a common prospective registry with matched photon comparators, pooled internationally. Existing trials (PARTIQoL in prostate, RADCOMP in breast, NRG lung and oesophageal trials) have struggled with accrual partly because patients can obtain protons outside trials. Pooling and conditioning payment fixes accrual and produces evidence proportionate to the investment already made in dozens of centres.

Hypothesis
Coverage-with-evidence conditions triple accrual to randomised proton versus photon trials within three years and produce definitive comparative results in at least three common adult indications within six.
Rationale
The Netherlands' model-based indication protocol and coverage-with-evidence in several US insurers show payers can condition access; the proton field itself has called for randomised evidence for two decades and has produced little because the incentives run the other way.
What would test it
Implement the condition across a payer coalition for two adult indications and compare trial accrual rates and time to completion with the period before.
Maturity
being tested at scale
Who has to act
payer
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks
  • Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
  • Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.

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