Patient Prioritization for Proton Beam Therapy in a Cost-neutral Payer Environment: Use of the Clinical Benefit Score for Resource Allocation

Abstract

Objectives There has been a rapid increase in the number of one- and two-room proton beam therapy (PBT) centers, which may be limited in the number of patients they can treat. The objective of this study was to analyze the impact of the 'clinical benefit score' (CBS), utilized as a method for treatment prioritization for PBT operating in a 'cost-neutral' proton-photon payer environment. Materials & methods This study includes patients considered for PBT at a center that initially had only one or two treatment rooms available for clinical use. Patients were prospectively scored using the CBS, and higher scores were prioritized. The outcome was receipt of PBT and the independent variable was CBS. Crude and adjusted analyses were performed using logistic regression. Results There were 2163 patients evaluated. A total of 205 patients (9.5%) were deemed candidates for PBT, which was received by 122 (5.6%) patients. In patients considered for PBT, the mean CBS was 18.7. Patients who were <21 years old, female, non-Caucasian, receiving re-irradiation, and those with Medicare had a higher CBS. Multivariate analysis adjusting for insurance status revealed both CBS and insurance to be significant predictors for receiving PBT. A unit increase in CBS was associated with 1.04 times increased odds of receiving PBT (OR=1.04, 95%CI: 1.01-1.07, p=0.0145) and having Medicare was associated with 3.13 times increased odds of receiving PBT (OR=3.13, 95%CI: 1.57-6.26, p=0.0012). Subgroup analysis, which only included patients enrolled prior to opening the second gantry, showed 1.05 times increased odds of receiving PBT per unit increase in CBS (OR=1.05, 95%CI: 1.00-1.10, p=0.03) and 2.87 times increased odds of receiving PBT in patients with Medicare (OR=2.87, 95%CI: 1.04-7.92, p=0.04). Conclusion The CBS utilized was significantly associated with the receipt of PBT in a cost-neutral payer setting. Physicians may consider the use of CBS as a resource allocation tool.

Keywords: clinical score; proton therapy; radiation; radiotherapy; resource allocation.