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

Purpose: Particle 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. Methods: Within 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. Results: Capital costs for the combined, proton-only and photon facilities are: Euro 138.6 million, Euro 94.9 million, Euro 23.4 million. Total costs per year are: Euro 36.7 million, Euro 24.9 million, Euro 9.6 million. Cost per fraction is: Euro 1128 (Euro 877-1974), Euro 743 (Euro 578-1300), Euro 233 (Euro 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 Euro 10,030 (c-ion: lung cancer) to Euro 39,610 (proton: head and neck tumors). Cost difference between particle and photon therapies is relatively small for lung and prostate cancer, larger for skull-base chordoma and head and neck tumors. Conclusion: Investment 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.