Pooled coverage-with-evidence for proton therapy across all centres
Proton therapy costs far more than standard radiotherapy and, for most adult cancers, nobody knows whether it is better. Payers would cover it only inside trials or registries that answer that question, across every centre at once.
National payers and proton centres agree that reimbursement for adult indications without established benefit is conditional on enrolment in pragmatic randomised trials (proton versus photon) or, where randomisation is unacceptable, in a common prospective registry with matched photon comparators, pooled internationally. Existing trials (PARTIQoL in prostate, RADCOMP in breast, NRG lung and oesophageal trials) have struggled with accrual partly because patients can obtain protons outside trials. Pooling and conditioning payment fixes accrual and produces evidence proportionate to the investment already made in dozens of centres.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.