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Sarah Emond
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For Immediate Release
Report on Proton Beam Therapy from the Institute for Clinical and Economic Review
(ICER) Shows Most Uses Not Supported by Evidence
-- Report Prepared for Washington State Health Care Authority -Boston, Mass., July 9, 2014 – The Institute for Clinical and Economic Review has produced a
final evidence report on the comparative clinical effectiveness and comparative value of proton
beam therapy (PBT) relative to conventional radiation treatments for 16 types of cancer and 3
benign tumors. The report, which highlighted the lack of evidence for most uses of PBT, was
prepared for the Washington State Health Technology Assessment program’s Health
Technology Clinical Committee and was an integral part of the ultimate coverage decision on
the use of PBT for individuals covered in the state’s Medicaid, public employee and workers’
compensation programs. The Clinical Committee arrives at a decision following an open,
transparent review of the evidence on safety, efficacy, and cost-effectiveness.
“Our independent and comprehensive review shows that while data exist to support the use of
PBT for a few select cancers, there is inadequate evidence to support its use across a broad
range of conditions,” said Steven D. Pearson, MD, MSc, President of ICER. “ICER is proud to
support public, transparent processes in which the evidence on clinical effectiveness and value
are considered together to make the best use of limited health care resources. This report
demonstrates the critical role that evidence-based medicine has in supporting high quality, high
value outcomes for patients, payers and physicians in Washington and across the nation.”
The American Cancer Society estimates that there are 14.5 million cancer survivors in America,
with approximately 1.7 million new diagnoses expected in 2014. Half of all patients diagnosed
with cancer will receive some form of radiation therapy as part of their treatment.
Proton beam therapy has attracted much clinical interest due to its physical properties, which
have the potential to deliver more accurately targeted radiation as well as to reduce the amount
of normal tissue exposed to radiation. Currently, there are 14 PBT centers across America, with
11 more planned or under construction. There is only sparse evidence comparing PBT to other
forms of radiation as well as alternative treatments. To date, there has been only one
randomized controlled trial comparing PBT to an alternative treatment, and few high-quality
observational studies are available.
Despite these limitations, ICER’s review found that PBT was superior to surgical treatment of
tumors of the eye, and appears to be a safer alternative to conventional radiation in brain and
spinal tumors as well as pediatric cancers, although most of the evidence in the latter two
conditions has been based on simulation modeling rather than actual clinical study.
There was insufficient evidence to determine whether PBT offers any improvement over
alternative treatments for many other conditions, including bone, breast, gastrointestinal, head
and neck cancers, lymphomas, and benign arteriovenous malformations.
For many other conditions, including prostate, liver and lung cancer, PBT provides comparable
outcomes but at greatly increased cost. Payments for PBT are typically 2-3 times higher than for
other forms of radiation treatment and may approach $50,000 per course of treatment in some
situations. The higher costs and limited evidence of effectiveness have prompted many
policymakers to carefully examine the circumstances under which PBT should be offered.
About ICER
The Institute for Clinical and Economic Review (ICER) is an independent non-profit health care
research organization dedicated to improving the interpretation and application of evidence in
the health care system. ICER directs two core programs: The California Technology Assessment
Forum (CTAF), and the New England Comparative Effectiveness Public Advisory Council
(CEPAC). For more information about ICER, please visit www.icer-review.org.
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