title: A systematic review of the cost and cost-effectiveness studies of proton radiotherapy.
abstract: BACKGROUND
  Economic analyses of new technologies, such as proton-beam radiotherapy (PBT), are a public health priority. To date, no systematic review of the cost-effectiveness of PBT has been performed.
  
  
  METHODS
  Systematic searches of PubMed, EMBASE, abstracts from American Society for Radiation Oncology and American Society of Clinical Oncology meetings, and the Cost-Effectiveness Analysis Registry were conducted (2000-2015) along with abstracts from the Particle Therapy Co-Operative Group of North America for both years of existence (2014-2015). Eighteen original investigations were analyzed.
  
  
  RESULTS
  The cost-effectiveness for prostate cancer-the single most common diagnosis currently treated with PBT-was suboptimal. PBT was the most cost-effective option for several pediatric brain tumors. PBT costs for breast cancer were increased but were favorable for appropriately selected patients with left-sided cancers at high risk of cardiac toxicity and compared with brachytherapy for accelerated partial breast irradiation. For non-small cell lung cancer (NSCLC), the greatest cost-effectiveness benefits using PBT were observed for locoregionally advanced-but not early stage-tumors. PBT offered superior cost-effectiveness in selected head/neck cancer patients at higher risk of acute mucosal toxicities. Similar cost-effectiveness was observed for PBT, enucleation, and plaque brachytherapy in patients with uveal melanoma.
  
  
  CONCLUSIONS
  With greatly limited amounts of data, PBT offers promising cost-effectiveness for pediatric brain tumors, well-selected breast cancers, locoregionally advanced NSCLC, and high-risk head/neck cancers. Heretofore, it has not been demonstrated that PBT is cost-effective for prostate cancer or early stage NSCLC. Careful patient selection is absolutely critical to assess cost-effectiveness. Together with increasing PBT availability, clinical trial evidence, and ongoing major technological improvements, cost-effectiveness data and conclusions from this analysis could change rapidly. Cancer 2016;122:1483-501. © 2016 American Cancer Society.
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Vivek
authors.initials: V
authors.lastname: Verma
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Mishra
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Minesh P
authors.initials: MP
authors.lastname: Mehta
mesh_terms: D001932:Brain Neoplasms / Q000191:economics / Q000532:radiotherapy; D001943:Breast Neoplasms / Q000191:economics / Q000532:radiotherapy; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D011471:Prostatic Neoplasms / Q000191:economics / Q000532:radiotherapy; D061766:Proton Therapy / Q000191:economics* / Q000379:methods*
keywords: cost-effectiveness; health care economics; operational costs; proton radiation therapy