The societal impact of ion beam therapy
The societal impact of ion beam therapy
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DOI：
10.1016/j.zemedi.2020.06.007
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发表时间：
2021-05-22
影响因子：
2
通讯作者：
Yan, Susu
中科院分区：
文献类型：
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作者：
Bortfeld, Thomas R.;de Viana, Matthew Fernandez;Yan, Susu
COVID-19大流行改变了世界，并转移了我们大部分的公共卫生能力。这种情况可能是暂时的，其他全球性挑战，特别是癌症，将重新成为焦点。然而，我们预计，危机将产生挥之不去的影响，在对社会造成的许多其他后果中，将引起金融审查，特别是在涉及大笔投资和昂贵技术时。被谴责为惊人的昂贵，离子束治疗（IBT）可能会受到额外的审查。批评IBT的声音会越来越大。人们会对粒子治疗中心提出轶事般的担忧，这些中心已经变成了白色大象，即维护成本高，而且不可能摆脱。比以往任何时候都更有必要证明IBT的可量化社会效益。一个广泛支持的量化疾病负担的卫生经济指标是残疾调整生命年（DALY）[1]。世界卫生组织将DALY定义为一种汇总指标，它结合了过早死亡损失的时间（定义为寿命损失年数（YLL））和低于最佳健康状态的时间（定义为残疾生活年数（YLD））[2]。从1990年至今，全球年龄标准化癌症死亡率下降了15%（德国为20%）[3]。由于癌症的存活率由于早期和更好的诊断以及更好的治疗选择而增加，我们需要考虑YLD而不是YLL。由于与放射治疗相关的残疾主要是由于损害健康组织，因此IBT现在与改善残疾更加相关[4-7]。原则上，如果IBT适用于每一位癌症患者，这种治疗可以大大降低癌症的DALY负担。然而，这种理想的情况并没有最终实现，因为IBT包括复杂和昂贵的系统，需要进一步的技术开发。许多研究和临床开发已经进行了超过
The COVID-19 pandemic has changed the world and has diverted much of our public health capacity. This situation will likely be temporary and other global challenges, in particular cancer, will come back into focus. However, we expect that there will be a lingering effect of the crisis that, among many other consequences for the society, will cause financial scrutiny especially when it comes to big investments and costly technology. Denounced as breathtakingly expensive, ion beam therapy (IBT) will likely come under extra scrutiny. Voices critical of IBT will get louder. People will raise anecdotal concerns over particle therapy centers that have become white elephants, ie, expensive to maintain and impossible to get rid of. More than ever it will be necessary to demonstrate a quantifiable societal benefit of IBT. A widely supported health economic metric to quantify disease burden is the disability adjusted life year (DALY)[1]. The WHO defines DALY as a summary measure that combines time lost through premature death defined as years of life lost (YLL) and time lived in states of less than optimal health defined as the years lived with disability (YLD)[2]. The agestandardized cancer death rate has declined globally by 15%(20% in Germany) between 1990 and today [3]. As the survival rate of cancer is increasing because of earlier and better diagnosis, and better treatment options, we need to consider YLD more than YLL. Since the disability associated with radiotherapy is largely due to damaging healthy tissues, IBT becomes now even more relevant to improving DALYs [4–7]. In principle, if IBT would be available to every cancer patient, this treatment could greatly reduce cancer burden in terms of DALY. However, this ideal scenario has not eventuated because IBT comprises complex and costly systems that require further technical development. A lot of research and clinical development has already been performed over the