How costly is particle therapy? Cost analysis of external beam radiotherapy with carbon-ions, protons and photons

PurposeParticle therapy has potentially a better therapeutic ratio than photon therapy. However, investment costs are much higher. This study provides an estimation and comparison of the costs of these therapies.MethodsWithin an extensive analytical framework capital and operational costs, cost per fraction, and four tumor specific treatment costs are calculated for three facilities: combined carbon-ion/proton, proton-only, and photon.ResultsCapital costs for the combined, proton-only and photon facilities are: € 138.6 million, € 94.9 million, € 23.4 million. Total costs per year are: € 36.7 million, € 24.9 million, € 9.6 million. Cost per fraction is: € 1128 (€ 877–1974), € 743 (€ 578–1300), € 233 (€ 190–407). Cost ratio particle/photon therapy is 4.8 for the combined and 3.2 for the proton-only facility. Particle treatment costs vary from € 10,030 (c-ion: lung cancer) to € 39,610 (proton: head & neck tumors). Cost difference between particle and photon therapies is relatively small for lung and prostate cancer, larger for skull-base chordoma and head & neck tumors.ConclusionInvestment costs are highest for the combined carbon-ion/proton facility and lowest for the photon facility. Cost differences become smaller when total costs per year and specific treatment costs are compared. Lower fractionation schedule of particle therapy might further reduce its costs.