Proton and Heavy Ion Therapy: An overview: January 2017
4
7.
There are no particle therapy facilities in Australia or New Zealand, although planning to
introduce this technology has commenced in a number of Australian States. For example,
Victoria has committed $50 million to the planning of a national proton beam facility at
Parkville. Additionally, there are formalised agreements between proposed facilities in New
South Wales, Queensland, and South Australian to construct an interstate network of proton-
only facilities, and one facility capable of delivering both carbon ions and protons. Finally,
there is also a private facility proposed for Queensland.
8.
Currently, Australian patients who may benefit from this technology can be referred to the
Australian Government’s Medical Treatment Overseas Program (MTOP),
which provides
funding support for eligible Australians to access treatments not available in Australia. Not all
patients requesting MTOP funding support for particle therapy overseas are granted approval,
which is determined on a case by case basis in accordance with strict criteria endorsed by
Cabinet, including consideration of whether effective alternative treatments to particle
therapy will be available in Australia in time to benefit the applicant in question. Within the
last five years, financial assistance for 24 patients was provided at a total cost of $3.4 million,
equating to an average of four patients per year, with an average treatment cost of $142,800
per patient. Costs are decreasing in recent years as the number of international providers
increases. At the request of the former Commonwealth Minister of Health, the Medical
Services Advisory Committee (MSAC) is reviewing the evidence around the clinical indications
for particle therapy, specifically protons, which have been previously granted approval through
the MTOP. The New Zealand Ministry for Health maintains a similar overseas referral program,
known as the High-Cost Treatment Pool (HCTP). Since 2005, there have been seven HCTP
applications approved for the treatment of ocular (eye) melanoma, at an average treatment
cost of NZ$35,000 per patient.
9.
If an Australian facility is established, domestic demand for particle therapy will be highly
dependent on the accepted clinical indications for referral. Conservative estimates for particle
therapy services in Australia and New Zealand equate to 600 to 900 patients per year.
Progressive estimates place demand at significantly higher numbers. The MSAC review of
MTOP referral indications could potentially provide greater certainty in this regard.
10.
Should planning processes occurring in some Australian States continue, consideration should
be given to the formation of a high-level national reference group with appropriate
government, clinical and scientific input. The role of this entity would be to oversee the
potential introduction of this technology into the healthcare systems of Australia and New
Zealand.
Proton and Heavy Ion Therapy: An overview: January 2017
5
HealthPACT Advice
This overview was commissioned by HealthPACT in response to a number of Australian
jurisdictions progressing with plans for the establishment of particle therapy facilities. Should
current planning processes continue, it is possible that that at least one facility could be operating
within 5-10 years.
The current clinical evidence-base supports the use of particle therapy in a limited range of clinical
indications, with small numbers of Australian and New Zealand patients referred overseas to
access this treatment. If a particle facility is established in Australia, patients clinically assessed as
requiring this treatment modality will no longer have access to MTOP funding. Additionally, with
no applicable Medical Benefits Scheme listing at present, funding for treatment would require that
costs are borne entirely by the States and Territories, or by the patient themselves. This raises
significant issues in relation to service funding, reimbursement, and equitable patient access to
treatment.
HealthPACT recommends a national approach to the development of appropriate patient
treatment criteria, investigation of the long-term affordability of particle therapy and
consideration of equitable patient access. HealthPACT further recommends, at an appropriate
time, the establishment a governance mechanism under the auspices of the Hospitals Principal
Committee regarding the potential introduction of this technology in Australia.
Proton and Heavy Ion Therapy: An overview: January 2017
6
Proton and Heavy Ion Therapy: An overview
This overview is provided due to the growing international diffusion of particle therapy
technology, and increasing interest in the establishment of a particle therapy technology as a
cancer treatment modality in Australia.
Introduction
Surgery, radiation therapy and chemotherapy are the standard methods of cancer treatment, with
conventional radiotherapy utilising photons (x-rays) generated by linear accelerators (LINAC’s).
However, as part of continued research into improved radiotherapy precision and biological
effectiveness, there is increasing international interest into the use of particle therapy (i.e. protons
or heavy ions) in the treatment of solid tumours. The use of protons for the treatment of cancer is
not a new technology, and has been undertaken internationally since the 1950’s
1
, with a marked
increase within the past two decades. More recently, the clinical use of heavy ions (such as
carbon, oxygen and fluorine) is being investigated. Although there are no particle therapy facilities
in Australia or New Zealand at this time, there is considerable international investment in this
technology. As at January 2017, there were 66 particle centres in operation (proton, carbon and
combined proton/carbon), and 61 centres either planned or under construction (Table 1).
Table 1
International particle therapy facilities and locations as at January 2017
2, 3
Particle Type
In operation
Under Construction
Planned
Total
No. of
Facilities
Locations
No. of
Facilities
Locations
No. of
Facilities
Locations
Proton Beam
Facilities
56 USA (24)
Japan (10)
Germany (4)
Russia (3)
France (2)
Italy (2)
Sth Korea (2)
Canada (1)
Czech Rep. (1)
China (1)
UK (1)
Poland (1)
Sth Africa (1)
Sweden (1)
Switzerland (1)
Taiwan (1)
39 USA (11)
China (6)
UK (6)
Japan (3)
India (2)
Netherlands (2)
Russia (2)
Denmark (1)
Abu Dhabi (1)
France (1)
Saudi Arabia (1)
Singapore (1)
Slovak Rep. (1)
Taiwan (1)
18 USA (3)
China (2)
Netherlands (2)
Switzerland (3)
Argentina (1)
Belgium (1)
India (1)
Japan (1)
Russia (1)
Singapore (1)
Slovak Rep. (1)
Taiwan (1)
113
Carbon Ion Facilities
5 Japan (4)
China (1)
1 China
7
Proton/Carbon Ion
Facilities
5 Germany (2)
China (1)
Italy (1)
Japan (1)
2 Austria (1)
South Korea (1)
1 USA
7
Total
66
42
19
127