title: Principles and reality of proton therapy treatment allocation.
abstract: OBJECTIVE
  To present the principles and rationale of the Proton Priority System (PROPS), a priority points framework that assigns higher scores to patients thought to more likely benefit from proton therapy, and the distribution of PROPS scores by patient characteristics
  
  
  METHODS
  We performed multivariable logistic regression to evaluate the association between PROPS scores and receipt of proton therapy, adjusted for insurance status, gender, race, geography, and the domains that inform the PROPS score.
  
  
  RESULTS
  Among 1529 adult patients considered for proton therapy prioritization during our Center's ramp-up phase of treatment availability, PROPS scores varied by age, diagnosis, site, and other PROPS domains. In adjusted analyses, receipt of proton therapy was lower for patients with non-Medicare relative to Medicare health insurance (commercial vs Medicare: adjusted odds ratio [OR] 0.47, 95% confidence interval [CI] 0.34-0.64; managed care vs Medicare: OR 0.40, 95% CI 0.28-0.56; Medicaid vs Medicare: OR 0.24, 95% CI 0.13-0.44). Proton Priority System score and age were not significantly associated with receipt of proton therapy.
  
  
  CONCLUSIONS
  The Proton Priority System is a rationally designed and transparent system for allocation of proton therapy slots based on the best available evidence and expert opinion. Because the actual allocation of treatment slots depends mostly on insurance status, payers may consider incorporating PROPS, or its underlying principles, into proton therapy coverage policies.
authors.affiliation: Department of Radiation Oncology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: bekelman@uphs.upenn.edu.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; The Wharton School and Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.affiliation: Department of Radiation Oncology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Zelig
authors.initials: Z
authors.lastname: Tochner
authors.affiliation: Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph
authors.initials: J
authors.lastname: Friedberg
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Vaughn
authors.affiliation: Department of Radiation Oncology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ellen
authors.initials: E
authors.lastname: Rash
authors.affiliation: Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Kevin
authors.initials: K
authors.lastname: Raksowski
authors.affiliation: Department of Radiation Oncology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hahn
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D002173:Cancer Care Facilities; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy*; D018579:Patient Selection; D015143:Philadelphia; D061766:Proton Therapy / Q000706:statistics & numerical data*; D044469:Racial Groups; D012737:Sex Factors; D014481:United States