Pay for a course of radiotherapy, not for each fraction
One week of breast radiotherapy in five doses works as well as three weeks in fifteen, but clinics paid per dose lose money by switching; paying one price per course removes the penalty.
Overview
FAST-Forward (Lancet 2020) showed 26 Gy in five fractions over one week was non-inferior to 40 Gy in fifteen fractions for local recurrence after breast surgery. Prostate, rectal, lung and palliative bone regimens have similar evidence. Fee-for-fraction payment makes the shorter course a revenue loss for the centre. Medicare's Radiation Oncology Model proposed episode payments; a simpler per-course rate for the common sites would align the incentive with the evidence.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Incentives reward me-too drugs and marginal gains · The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure.
- Knowledge reaches practice too slowly · Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.
Pages like this
not linked directly; found by shared links- IdeaMake one-week radiotherapy the default in overloaded systems
Shares Knowledge reaches practice too slowly, Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
- IdeaPay per course of radiotherapy, not per session, so short courses are not penalised
Shares Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy), Incentives reward me-too drugs and marginal gains, IMRT / IGRT (modern external beam).
- PersonTheodore S. Lawrence
Shares American Society for Radiation Oncology, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
- CompanyZAP Surgical Systems
Shares SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
- PersonAnthony L. Zietman
Shares American Society for Radiation Oncology, IMRT / IGRT (modern external beam), Prostate cancer.
- IdeaA public fund and label pathway to trial generic drugs against cancer
Shares Incentives reward me-too drugs and marginal gains, Prostate cancer, HR-positive / HER2-negative breast cancer.
- CompanyXcision Medical Systems
Shares SBRT / SABR (stereotactic radiotherapy), HR-positive / HER2-negative breast cancer.
- IdeaAdvanced-practice radiation therapists doing contouring and on-treatment reviews
Shares Surgery and radiotherapy cure most, get least, IMRT / IGRT (modern external beam).