by Sean Ruck
, Contributing Editor | March 22, 2019
From the March 2019 issue of HealthCare Business News magazine
Even though we have seen positive growth in access to proton therapy for cancer patients, 30 centers in the U.S. pales in comparison to the 2,100+ standard radiation therapy facilities that exist today. Our data reflects that 65 percent of the cancer patients across the country do not have reasonable access to a proton therapy facility.
HCB News: Can you provide the 2018 numbers on how many patients were treated and what kind of growth that represents for the sector?
At this time, we do not have actual data on the number of patients that were treated in 2018, but estimates from our previous annual proton therapy provider surveys reflect that over 10,500 patients were treated with proton therapy in the U.S. in 2018. Trends indicate that over a five-year period, proton therapy for prostate cancer has decreased significantly as a percentage of all indications treated as result of significant growth in the volume of other indications. This is evidenced by a 50 percent increase in the treatment of central nervous system tumors, pediatric treatments increasing by 62 percent, head and neck cancer treatments more than tripling, and breast cancer treatments increasing seven-fold.
HCB News: How has the drive to increase insurer reimbursement progressed since we last spoke?
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Ensuring patient choice and access to proton therapy is part of our mission and so is always a focus. In 2018, we had several initiatives that resulted in positive progress for our members and cancer patients across the country. One of those efforts resulted in two important indications, esophagus and head and neck cancers, being removed from a major benefit manager’s experimental, investigational, or unproven status, resulting in cancer patients with these indications having a much easier pathway to coverage approval than available before.
HCB News: Are there any other initiatives NAPT is heading at the moment?
As you can imagine, we have several major initiatives ongoing, including our ASSURE (Assuring Satisfactory Scientific Use Review of Evidence) Initiative. In our research, the clinical evidence used by payers and radiation oncology benefit managers to support their proton therapy coverage policies – we discovered their review of the most important and recent clinical evidence inadequate. To ensure that these entities were performing adequate reviews of the clinical evidence, the ASSURE Initiative was developed. The goal of the ASSURE Initiative is to utilize our member physician experts to perform disease‐specific evidence assessments for comparison to payers, radiation oncology benefit managers (ROBMs) and other organizations’ coverage policies. The NAPT selected head and neck cancer as the initial disease site due to the advantages the clinical research has reflected these patients gain from receiving proton therapy over other radiation therapy techniques. Once the clinical evidence assessment was complete, it was compared to payers’ and ROBMs’ coverage policies, noting stark contrasts in the number of references and recent evidence used to develop the policy. One example reflected that while the NAPT model policy referenced 87 clinical research papers, 39 from 2015 or later, the payer referenced three papers with none of those coming from 2015 or later. Endorsed by over 40 of our member physicians, individual comparisons were developed for every payer and ROBM, and recently forwarded to their chief medical officers for review. Our hope is that this initiative will hold payers and ROBMs accountable to performing adequate and fair reviews of the clinical evidence.