Indiana University Health Proton Therapy Center, Bloomington, Indiana.
Indiana University Health Proton Therapy Center, Bloomington, Indiana; Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
Int J Radiat Oncol Biol Phys. 2014 Jun 1;89(2):235-40. doi: 10.1016/j.ijrobp.2014.02.014. Epub 2014 Mar 27.
To determine whether all the existing and planned proton beam therapy (PBT) centers in the United States can survive on a local patient mix that is dictated by insurers, not by number of patients.
We determined current and projected cancer rates for 10 major US metropolitan areas. Using published utilization rates, we calculated patient percentages who are candidates for PBT. Then, on the basis of current published insurer coverage policies, we applied our experience of what would be covered to determine the net number of patients for whom reimbursement is expected. Having determined the net number of covered patients, we applied our average beam delivery times to determine the total number of minutes needed to treat that patient over the course of their treatment. We then calculated our expected annual patient capacity per treatment room to determine the appropriate number of treatment rooms for the area.
The population of patients who will be both PBT candidates and will have treatments reimbursed by insurance is significantly smaller than the population who should receive PBT. Coverage decisions made by insurers reduce the number of PBT rooms that are economically viable.
The expansion of PBT centers in the US is not sustainable under the current reimbursement model. Viability of new centers will be limited to those operating in larger regional metropolitan areas, and few metropolitan areas in the US can support multiple centers. In general, 1-room centers require captive (non-PBT-served) populations of approximately 1,000,000 lives to be economically viable, and a large center will require a population of >4,000,000 lives. In areas with smaller populations or where or a PBT center already exists, new centers require subsidy.
确定美国现有的和计划中的所有质子束治疗 (PBT) 中心是否能够仅依靠保险公司规定的本地患者群体生存，而不是依靠患者数量。
我们确定了美国 10 个主要大都市区目前和预计的癌症发病率。使用已发表的利用率，我们计算出适合 PBT 的患者比例。然后，根据当前公布的保险公司承保政策，我们根据我们的经验来确定有多少患者可以得到报销，从而确定预期的净报销患者数量。确定了净报销患者数量后，我们将平均光束输送时间应用于治疗过程，以确定每位患者所需的总治疗时间。然后，我们计算出每个治疗室每年预计的患者容量，以确定该地区所需的治疗室数量。
有资格接受 PBT 治疗且治疗费用可由保险公司报销的患者数量明显小于应接受 PBT 治疗的患者数量。保险公司的承保决策减少了具有经济效益的 PBT 治疗室数量。
在美国，按照当前的报销模式，PBT 中心的扩张是不可持续的。新中心的可行性将仅限于在较大的区域大都市区运营，而美国很少有大都市区能够支持多个中心。一般来说，一个治疗室的中心需要大约 100 万的非 PBT 服务人群才能具有经济效益，而一个大型中心需要 >400 万的人口。在人口较少的地区或已经存在 PBT 中心的地区，新中心需要补贴。
