Tuesday, August 04, 2015

The medical arms race made visible

With thanks to Priyanka Dayal McCluskey at the Boston Globe, we can get a glimpse of one "small" part of the medical arms race in action.  The story is about the expansion of Mevion Medical Systems Inc., a manufacturer of proton beam machines.  The company offers the "more affordable price tag of about $25 million" per machine, compared to the first generation $250 million models.

Here's the arms race quote:

Three Mevion systems are treating patients at hospitals in St. Louis, Jacksonville, Fla., and New Brunswick, N.J. Four others are being installed. The company is developing about 20 other orders. 

Here's the relevant context:

“In a perfect world, if the capital costs were the same, proton therapy is something you’d want all patients to receive,” [MGH's Jay] Loeffler said, “but because of the capital costs, it has to be limited in use to only the situations we believe it’s best for.” This includes tumors in children and tumors in adults that are in or near critical body parts like the brain or eyes.
Some hospitals use proton therapy to treat prostate cancer — even when there is no scientific evidence it’s a more effective treatment than traditional radiation, said Dr. Durado Brooks, director of cancer control intervention for the American Cancer Society.
“Because it’s newer doesn’t necessarily mean it’s better’’ for prostate cancer, he said. “At this point we just don’t know.” 
Here's an endorsement about the science behind the machine presented on the company's website:

What is American Shared Hospital Services?

American Shared Hospital Services is a publicly traded healthcare company (New York Stock Exchange AMEX symbol AMS) with a 25-year track record of leasing state-of-the-art medical equipment to hospitals and medical centers in the United States.

Through GK Financing, LLC (GKF), our majority owned subsidiary, we are the leader in Gamma Knife unit ownership with approximately a 16% market share in the United States. Our Gamma Knife model has been expanded to incorporate the financing of other technology solutions including Intensity Modulated Radiation Therapy (IMRT), Image-Guided Radiation Therapy (IGRT) and Proton Beam Radiation Therapy (PBRT).

In the corporate history, we note these items:

2006: We enter the proton beam radiation therapy (PBRT) market by acquiring an equity interest in Still River Systems, Inc., developer of the Monarch 250, a practical, cost-efficient, single room PBRT system. In turn, we are able to contract with Tufts Medical Center in Boston, MA. for a complete radiation therapy department upgrade that includes an IMRT/IGRT as well as a single-room PBRT system. 

We contract with Orlando Regional Healthcare M.D. Anderson Cancer Center in Orlando, FL on our second single-room PBRT facility. 

2007: We increase our equity interest in Still River Systems, Inc.

2008: We agree to provide Todd Cancer Institute at Long Beach Memorial Hospital, in Long Beach, CA with a single-room PBRT facility – our third to date. 

2009: We sign a letter of intent with the Todd Cancer Institute at Long Beach Memorial Hospital, in Long Beach, CA for a single-room PBRT facility – our third to date. 
I know you'll join me in being glad that ASHS has no vested interest in this product and is highly qualified to present a scientific opinion!
Let's recap. "We just don't know" if it's better, but Mevlon has sold or will sell 27 installations at $25 million, or $675 million.  Oh, aided and abetted by a Medicare pricing regime that provides higher rates for use of the machine.  The company notes:
Treatment sites where proton therapy is used:

Pediatric Tumors
Head and Neck

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