title: In search of the economic sustainability of Hadron therapy: the real cost of setting up and operating a Hadron facility.
abstract: OBJECTIVE
  To determine the treatment cost and required reimbursement for a new hadron therapy facility, considering different technical solutions and financing methods.
  
  
  METHODS
  The 3 technical solutions analyzed are a carbon only (COC), proton only (POC), and combined (CC) center, each operating 2 treatment rooms and assumed to function at full capacity. A business model defines the required reimbursement and analyzes the financial implications of setting up a facility over time; activity-based costing (ABC) calculates the treatment costs per type of patient for a center in a steady state of operation. Both models compare a private, full-cost approach with public sponsoring, only taking into account operational costs.
  
  
  RESULTS
  Yearly operational costs range between €10.0M (M = million) for a publicly sponsored POC to €24.8M for a CC with private financing. Disregarding inflation, the average treatment cost calculated with ABC (COC: €29,450; POC: €46,342; CC: €46,443 for private financing; respectively €16,059, €28,296, and €23,956 for public sponsoring) is slightly lower than the required reimbursement based on the business model (between €51,200 in a privately funded POC and €18,400 in COC with public sponsoring). Reimbursement for privately financed centers is very sensitive to a delay in commissioning and to the interest rate. Higher throughput and hypofractionation have a positive impact on the treatment costs.
  
  
  CONCLUSIONS
  Both calculation methods are valid and complementary. The financially most attractive option of a publicly sponsored COC should be balanced to the clinical necessities and the sociopolitical context.
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Gent, Belgium. Electronic address: barbara.vanderstraeten@uzgent.be.
authors.forename: Barbara
authors.initials: B
authors.lastname: Vanderstraeten
authors.affiliation: Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Verstraete
authors.affiliation: Belgian Hadron Therapy Center Foundation, Brussels, Belgium.
authors.forename: Roger
authors.initials: R
authors.lastname: De Croock
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Gent, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Neve
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Gent, Belgium.
authors.forename: Yolande
authors.initials: Y
authors.lastname: Lievens
mesh_terms: D000066:Accounting / Q000379:methods*; D019985:Benchmarking / Q000191:economics; D002173:Cancer Care Facilities / Q000191:economics* / Q000458:organization & administration; D002202:Capital Financing / Q000191:economics / Q000379:methods; D003131:Combined Modality Therapy / Q000191:economics / Q000379:methods; D003365:Costs and Cost Analysis / Q000379:methods; D005240:Feasibility Studies; D005380:Financing, Government / Q000191:economics / Q000379:methods; D017048:Health Care Costs; D058016:Health Facility Administration / Q000191:economics; D063193:Heavy Ion Radiotherapy / Q000191:economics* / Q000379:methods; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008283:Maintenance / Q000191:economics; D018803:Models, Economic; D010561:Personnel Staffing and Scheduling / Q000191:economics; D061766:Proton Therapy / Q000191:economics* / Q000379:methods