ROBERT SIEGEL, HOST:
Proton therapy has been touted as the next big thing in cancer care. It requires massive machines that are housed in facilities the size of football fields. These centers have been constructed at a rapid pace for a decade all over the country, but one proton therapy center in Indiana has unexpectedly announced that it will close its doors. Reporter Jenny Gold has more.
JENNY GOLD, BYLINE: There are 14 proton therapy centers in the U.S. and another dozen facilities are under construction. Each can cost $200 million to build. So when Indiana University announced last month that it plans to close down its facility in Bloomington, it was something of a shock.
AMITABH CHANDRA: I never thought that in my lifetime I would see a proton center close.
GOLD: Amitabh Chandra is a professor at Harvard's Kennedy School of Government who studies the cost of American medical care. He's surprised because until now industry growth has been entirely in the other direction, even though there's little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.
CHANDRA: But we do know that it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology.
GOLD: In the Washington, D.C. area alone, there are three proton therapy centers under construction. One at Johns Hopkins' Sibley Hospital, another at Medstar's Georgetown Hospital and a third slated to open at the University of Maryland in Baltimore next year. All three say they are continuing to build their centers despite the news out of Bloomington.
But in Indiana, a review committee determined that it just wasn't worth spending the money to update their proton facility. One reason was insurers have been refusing to cover treatment. Cigna, for example, only covers proton therapy for a single rare eye cancer, says national medical officer Dr. David Finley.
DAVID FINLEY: When it's used, however, for all other tumors, it has not been shown to be any more effective than other forms - more standard forms of radiation therapy.
GOLD: But, he says, it can cost three to six times as much for illnesses like prostate cancer. And when insurers pay for expensive care that isn't any better than the cheaper options, he explains, it can increase the costs of everyone's health care.
FINLEY: We say, well, if two services offer the same results and one is much more expensive than the other one, we're only going to pay for the one that is less expensive.
GOLD: Other major insurers have also limited what they'll cover with proton therapy, including Aetna and Blue Shield of California. But in Washington, D.C., the hospitals aren't fazed by the insurance industry's decision. In e-mail statements, all three hospital said construction is continuing and they are confident that their centers will be a success. Two said that the larger population of the D.C.-Baltimore area can support a proton facility better than a small city like Bloomington. The third said it's building a smaller one-room center that will be more cost-effective.
One insurer that has not put any restrictions on proton therapy is Medicare, and Medicare pays much more for it than they pay for standard radiation therapy. Here's Harvard's Amitabh Chandra again.
CHANDRA: That's the problem with Medicare payment policy - is that it not only covers treatments that are dubious, it covers dubious treatments extremely generously.
GOLD: But facilities like the ones in Washington, D.C., think it's just a matter of time before clinical trials prove that proton therapy is worth the cost. For NPR News, I'm Jenny Gold.
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