Top Line: Proton therapy costs more, but how much more.
The Study: Here is a Belgian economic evaluation comparing proton therapy vs photon breast radiation (both free-breathing and DIBH). Using a state-transition microsimulation of one million patients, the model integrated NTCP-based risks for cardiovascular disease, lung cancer, contralateral breast cancer, and pneumonitis. The upfront willingness to pay threshold was 45K euro (roughly $54K) per quality-adjusted life year gained. Unsurprisingly, protons did not fare well. Even when looking only at a population set-up to benefit (read: left-sided regional nodal irradiation in patients with moderate to high baseline cardiovascular risk) the gain of one quality-adjusted life year with protons versus free-breathing photons came at an incremental cost of €292,438 and surpassing an eye-watering >€700,000 when compared to breath-hold photons. In fact, proton therapy failed to demonstrate cost-effectiveness compared to breath-hold photons across even the most ambitiously contrived subgroups. These findings land alongside early RADCOMP data where proton therapy unsurprisingly showed no clinically meaningful differences at 6 months.
TBL: Proton therapy for routine breast radiation remains a tough sell. | Busschaert, JAMA Netw Open 2026
The Study: Here is a Belgian economic evaluation comparing proton therapy vs photon breast radiation (both free-breathing and DIBH). Using a state-transition microsimulation of one million patients, the model integrated NTCP-based risks for cardiovascular disease, lung cancer, contralateral breast cancer, and pneumonitis. The upfront willingness to pay threshold was 45K euro (roughly $54K) per quality-adjusted life year gained. Unsurprisingly, protons did not fare well. Even when looking only at a population set-up to benefit (read: left-sided regional nodal irradiation in patients with moderate to high baseline cardiovascular risk) the gain of one quality-adjusted life year with protons versus free-breathing photons came at an incremental cost of €292,438 and surpassing an eye-watering >€700,000 when compared to breath-hold photons. In fact, proton therapy failed to demonstrate cost-effectiveness compared to breath-hold photons across even the most ambitiously contrived subgroups. These findings land alongside early RADCOMP data where proton therapy unsurprisingly showed no clinically meaningful differences at 6 months.
TBL: Proton therapy for routine breast radiation remains a tough sell. | Busschaert, JAMA Netw Open 2026