TY - JOUR
T1 - Principles and reality of proton therapy treatment allocation
AU - Bekelman, Justin E.
AU - Asch, David A.
AU - Tochner, Zelig
AU - Friedberg, Joseph
AU - Vaughn, David J.
AU - Rash, Ellen
AU - Raksowski, Kevin
AU - Hahn, Stephen M.
N1 - Copyright © 2014 Elsevier Inc. All rights reserved.
PY - 2014/7/1
Y1 - 2014/7/1
N2 - Purpose To present the principles and rationale of the Proton Priority System (PROPS), a priority points framework that assigns higher scores to patients thought to more likely benefit from proton therapy, and the distribution of PROPS scores by patient characteristics Methods and Materials We performed multivariable logistic regression to evaluate the association between PROPS scores and receipt of proton therapy, adjusted for insurance status, gender, race, geography, and the domains that inform the PROPS score. Results Among 1529 adult patients considered for proton therapy prioritization during our Center's ramp-up phase of treatment availability, PROPS scores varied by age, diagnosis, site, and other PROPS domains. In adjusted analyses, receipt of proton therapy was lower for patients with non-Medicare relative to Medicare health insurance (commercial vs Medicare: adjusted odds ratio [OR] 0.47, 95% confidence interval [CI] 0.34-0.64; managed care vs Medicare: OR 0.40, 95% CI 0.28-0.56; Medicaid vs Medicare: OR 0.24, 95% CI 0.13-0.44). Proton Priority System score and age were not significantly associated with receipt of proton therapy. Conclusions The Proton Priority System is a rationally designed and transparent system for allocation of proton therapy slots based on the best available evidence and expert opinion. Because the actual allocation of treatment slots depends mostly on insurance status, payers may consider incorporating PROPS, or its underlying principles, into proton therapy coverage policies.
AB - Purpose To present the principles and rationale of the Proton Priority System (PROPS), a priority points framework that assigns higher scores to patients thought to more likely benefit from proton therapy, and the distribution of PROPS scores by patient characteristics Methods and Materials We performed multivariable logistic regression to evaluate the association between PROPS scores and receipt of proton therapy, adjusted for insurance status, gender, race, geography, and the domains that inform the PROPS score. Results Among 1529 adult patients considered for proton therapy prioritization during our Center's ramp-up phase of treatment availability, PROPS scores varied by age, diagnosis, site, and other PROPS domains. In adjusted analyses, receipt of proton therapy was lower for patients with non-Medicare relative to Medicare health insurance (commercial vs Medicare: adjusted odds ratio [OR] 0.47, 95% confidence interval [CI] 0.34-0.64; managed care vs Medicare: OR 0.40, 95% CI 0.28-0.56; Medicaid vs Medicare: OR 0.24, 95% CI 0.13-0.44). Proton Priority System score and age were not significantly associated with receipt of proton therapy. Conclusions The Proton Priority System is a rationally designed and transparent system for allocation of proton therapy slots based on the best available evidence and expert opinion. Because the actual allocation of treatment slots depends mostly on insurance status, payers may consider incorporating PROPS, or its underlying principles, into proton therapy coverage policies.
KW - Adult
KW - Age Factors
KW - Aged
KW - Algorithms
KW - Cancer Care Facilities
KW - Female
KW - Humans
KW - Insurance Coverage/statistics & numerical data
KW - International Classification of Diseases
KW - Logistic Models
KW - Male
KW - Medicare/statistics & numerical data
KW - Middle Aged
KW - Neoplasms/classification
KW - Patient Selection
KW - Philadelphia
KW - Proton Therapy/statistics & numerical data
KW - Racial Groups
KW - Sex Factors
KW - United States
UR - http://www.scopus.com/inward/record.url?scp=84902140044&partnerID=8YFLogxK
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=purepublist2023&SrcAuth=WosAPI&KeyUT=WOS:000337219400013&DestLinkType=FullRecord&DestApp=WOS
U2 - 10.1016/j.ijrobp.2014.03.023
DO - 10.1016/j.ijrobp.2014.03.023
M3 - Article
C2 - 24798985
SN - 0360-3016
VL - 89
SP - 499
EP - 508
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 3
ER -