Reference pricing for PBRT in treatment of prostate cancer?

One of the lead specialists in the use of proton beam radiation therapy (PBRT) in the treatment of prostate cancer is suggesting that use of this technology should be reimbursed at the same rate as intensity-modulated radiation therapy (IMRT) — at least until we have better data.

The proposal by Justin Bekelman, MD, a radiation oncologist at the University of Pennsylvania is outlined in a media release issued by Penn Medicine, and in an article by Bekelman and Hahn in yesterday’s issue of the Journal of Clinical Oncology.

This makes perfect sense to The “New” Prostate Cancer InfoLink. No one is suggesting that PBRT “doesn’t work” in the treatment of prostate cancer. Clearly it does. But what is missing is concrete evidence that PBRT is worth paying nearly twice as much for compared to IMRT. Without such evidence, such claims are simply unrealistic, and insurers aren’t going to go on footing the bill just because more PBRT centers are getting built.

With simple reference pricing in place, the onus would then be on the PBRT centers to clearly demonstrate that PBRT really is so much better than IMRT that it is worth paying more for. It’s not an unreasonable request, and the “New” Prostate Cancer InfoLink congratulates Dr. Bekelman and his colleagues for their recommendation, which is entirely in line with suggestions that we made some time ago.

One Response

  1. Sheesh! Maybe this is one, or the only, reason the Uppsala doctors decided to offer me trimodal therapy (EBRT, HDR brachytherapy, ADT) instead of PBRT. I never thought of this possibility, although it is nearly certain that the reasons I was given were excellent.

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