Best technology first

Proton Therapy

An announcement in the past year that the UK’s NHS would be expanding the availability of proton therapy — a 40 year old technology — does make one wonder. Of course, proton therapy is pricey for the underlying technology, but its precision and better beam control adds benefits when one moves beyond a simple cost model (proton therapy suites run around $125 million or so) to whole system thinking.

Isolating the costs of particular pieces of equipment leads to a tiering of diagnostic procedures, use of protocols around narrow areas of diagnostic accuracy, and ensure that patients will experience simpler technologies first before progressively better diagnostic accuracy is needed; in effect the patient is forced to endure uncertainly as the clinical decision system moves to the more certain, but less available technologies.  MRI technologies provide more certain diagnosis, and a quicker diagnosis can lead to starting treatment sooner, or importantly, ruling out further treatment.

My view is that by using the best technology first, the whole systems costs of diagnosis, treatment, patient time, clinical on-costs, and waiting, anxiety, etc. can be bundled more tightly together. This eliminates wasting clinical time through duplication of procedures, but using different technologies each time. The advantage of more advanced technologies like the MRI is also reduced exposure to radiation (which is more likely with combinations of x-ray and CT as steps along the clinical diagnostic pathway.