Reimbursement for PBRT in the treatment of prostate cancer

According to a “model policy” statement just issued by the American Society for Radiation Oncology (ASTRO), reimbursement for costs related to the treatment of prostate cancer with proton beam radiation therapy (PBRT) should come with some very specific requirements.

These requirements are that either the patients should have been enrolled in well-characterized clinical trials or defined patient data is captured and included in a well-characterized, multi-institutional registry database.

For a longer discussion of this model policy statement from ASTRO, please see this article on the MedPage Today web site or the actual model policy statement on the ASTRO web site.

It is clear that the National Association for Proton Therapy (NAPT), a trade organization representing the PBRT industry, is not happy about this new model policy. It will be interesting to see whether CMS and/or the commercial payers are going to side with ASTRO or with the NAPT on this issue.

The “New” Prostate Cancer InfoLink wants to be very clear that, in our minds, prostate cancer patients who want to have PBRT should be able to get this, and appropriate costs should be covered, but it would certainly be of long-term benefit to the prostate cancer community as a whole if all such patients were either enrolled in sound clinical trials or were being asked to provide de-identified data to high quality, multi-institutional registry initiatives. We really need to know whether PBRT is as good or better than other forms of radiation therapy in the treatment of localized prostate cancer. As yet we do not have those data.

We should note that ASTRO’s model policy lays out the same requirements for other types of common cancer, specifically including head and neck and lung cancers (and probably breast cancers too). In other words, no one is “picking on” prostate cancer. Furthermore, ASTRO is careful to distinguish between its “model policies” and its “clinical guidelines”, and is clear that model policies are not clinical guidelines. ASTRO has previously issued “model policies” on several other forms of radiation treatment used in the management of prostate cancer, including:

  • Brachytherapy (radioactive seed implantation)
  • Intensity-modulated radiation therapy (IMRT)
  • Stereotactic body radiation therapy (SBRT)
  • Stereotactic radiosurgery (SRS)

One Response

  1. I am sure I do not understand all the factors involved in these policy statements. And although I probably would not choose PBT as a treatment, the method does seem to be held to a higher standard. It does appear part of this is due to cost, in which case such policies set a precedent that perhaps may discourage new technologies and innovation.

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