In Search of the Economic Sustainability of Hadron Therapy: The Real Cost of Setting Up and Operating a Hadron Facility

Purpose: To determine the treatment cost and required reimbursement for a new hadron therapy facility, considering different technical solutions and financing methods. Methods and Materials: The 3 technical solutions analyzed are a carbon only (COC), proton only (POC), and combined (CC) center, each operating 2 treatment rooms and assumed to function at full capacity. A business model defines the required reimbursement and analyzes the financial implications of setting up a facility over time; activity-based costing (ABC) calculates the treatment costs per type of patient for a center in a steady state of operation. Both models compare a private, full-cost approach with public sponsoring, only taking into account operational costs. Results: Yearly operational costs range between (sic)10.0M (M Z million) for a publicly sponsored POC to (sic)24.8M for a CC with private financing. Disregarding inflation, the average treatment cost calculated with ABC (COC: (sic)29,450; POC: (sic)46,342; CC: (sic)46,443 for private financing; respectively (sic)16,059, (sic)28,296, and (sic)23,956 for public sponsoring) is slightly lower than the required reimbursement based on the business model (between (sic)51,200 in a privately funded POC and (sic)18,400 in COC with public sponsoring). Reimbursement for privately financed centers is very sensitive to a delay in commissioning and to the interest rate. Higher throughput and hypofractionation have a positive impact on the treatment costs. Conclusions: Both calculation methods are valid and complementary. The financially most attractive option of a publicly sponsored COC should be balanced to the clinical necessities and the sociopolitical context. (C) 2014 Elsevier Inc.