Proton Therapy Congress 2016

Health economics in high-cost cancer

Prof Nick Bosanquet – Imperial College London, London, UK 

The conference really comes at a very exciting moment when access to proton therapy is going to vastly increase in the UK. If this had been ten years ago the funding would have been much easier but it is going to have to win support and win referrals in a very much tougher environment than was the case ten years ago. One reason is that there are other pressures on funding from education, the effects of Brexit and so on, as well as on the Health Service. Also there is more concern about the funding pressures in specialist commissioning which covers 150 different services and where the spend is now £15 billion rising to £19 billion over the next five or six years which is more than the national spend on primary care for 60 million people. So proton therapy is going to have to get funding and get support in a very difficult environment but much of this conference has shown that there are positive ways of doing that.

Could you discuss your presentation?

I argue that proton therapy must first of all show how it can lead to a care pathway in which proton therapy leads to much better quality of life over a long period of time and much greater opportunities for individuals because they don’t lose cognitive ability and they don’t have serious problems with continence in the case of prostate cancer. It can’t just be a one-off episode of treatment, it’s got to be a lifetime investment. The evidence from Florida and elsewhere, which was given us earlier, shows that it’s possible that adult patients can also benefit greatly from proton therapy as well as child patients.

The second thing that proton therapy has to do is to show that it can deliver at a lower cost than the £100,000 per patient which has been the cost of sending kids abroad in the past and that it also can improve the patient experience because, for children who’ve been abroad, the parents and carers have to be away for eight or ten weeks. Although their travel costs may be reimbursed, they are losing work time and also are getting quite a lot of incidental costs and maybe they have to pay for support of other children who are left at home as well. So we’ve got to improve the patient experience and try to make the treatment shorter, involving less travel time, because even with two centres in Manchester and London there could be quite a lot of travel time. There’s a lot of space in between Manchester and London where people live and people are going to go to those centres and have a patient-friendly experience for this lifetime investment.

What about the issue of outcomes?

There’s been a lot of concern about the Cancer Drugs Fund because only about 9% of the patients who got drugs under the Fund had any information on outcomes. There may have been less good results in outcomes and more side effects than perhaps were realised. The proton therapy community has got to get together to establish a database so that they can track across all centres for specific groups of patients what the outcomes have been. This has been done in Florida and is producing some very useful results showing, for example, that proton therapy can produce more positive results for patients with medium or high risk prostate cancer than other types of therapy. They’ve got to set an example, the proton therapy centres have to set an example in producing a UK-wide database covering the private and public sector on the gains and results from proton therapy.

This is a new start, we haven’t had proton therapy, intensive proton therapy, before so there’s a chance to jump the queue or establish a good reputation for the kind of metrics which are becoming essential for any programme that wants to compete for public funding nowadays.

Any final thoughts?

Clearly the gains to children are great from proton therapy with certain kinds of tumours and at present only 200, less than 200, are actually getting the treatment when it could be as high as 1,500. I hope that we can accelerate access to the treatment and that there will be collaboration between public and private sectors so that if the private sector facilities start earlier then we begin to get experience by sending NHS patients to those centres. The sooner the metrics start and the sooner the brain storming about cost reduction starts, the better because the next five years are going to be a very tough period for public spending.  We already have a large debt and there are some signs of it getting larger. The tax revenues are going to be at higher risk with Brexit even if there are longer term gains which may materialise and also we are running out of younger tax payers. A lot of health funding goes to people who enjoy public services, I am one of them, I am not in that case, but don’t actually pay very much tax. Proton therapy might help the cognitive abilities of young kids so they can grow up to be more effective in work and develop their careers more strongly which will be a good thing in itself quite apart from their tax paying abilities.