State of the Proton Therapy Market entering 2017

Scott Owens, Managing Director, Robust Insight Ltd

scott@robust-insight.co.uk
Robust Insight Ltd | www.robust-insight.co.uk | Regent's Court, Princess Street, Hull, UK HU2 8BA
01
Proton Therapy Market Study
Method and Demographics
Who wants Proton Therapy
Benefits of Proton Therapy
Barriers to Growth
Believe in the Future
Markets
Conclusion

2
Methodology
Robust Insight Ltd, an independent market research consultancy, was commissioned by
IBA to undertake an online survey with 1,200 hospitals to better understand their use of
and attitudes towards Proton Therapy

A total of 222 replies were received from 205 institutions in 29 countries giving a
response rate of 19%

The results of some questions have been compared with the last time the study was run
in 2009

In the analysis, organizations not active in cancer treatment now have been removed

Robust Insight Ltd | www.robust-insight.co.uk | Regent's Court, Princess Street, Hull, UK HU2 8BA 3
Demographics
Region Interest in Proton Therapy Primary Role
North America Western Europe Other
Medical Physicist 31%
Already purchased/ using 36%
Radiation Oncologist 17%

Physician / MD 14%
11%
Actively considering 22%
Allied Health Professional 11%

Board Member 3%
Actively considered and
14%
decided no Practice Manager / Hospital
Administrator
3%
34% 55%
Surgeon 2%
Not enough information 10%
CEO / MD 0%

CFO or Equivalent Capacity 0%

Not interested 17%
Others 18%

Which country is your practice based in? n=222 How would you characterize your centers current level of interest in What is your primary role in a hospital? n=222
Proton Therapy? n=201

A large proportion of the respondents are already familiar with

Proton Therapy 4
02
Proton Therapy Market Study
Method and Demographics
Who wants Proton Therapy
Benefits of Proton Therapy
Barriers to Growth
Believe in the Future
Markets
Conclusion

5
 Support for Proton Therapy
To what extent did the following groups support or oppose the
decision to invest in Proton Therapy? Radiation Physicists and Radiation
Oncologists were the most likely groups to
Radiation Physicists 1.8 support Proton Therapy
Radiation Oncologists 1.6
Insurance Payers were the only group seen
Department Chair 1.1
to oppose Proton Therapy
Patient organizations 1.0

Board of Directors 0.8 Mean score

C-Level Executives 0.6

Medical Oncologists 0.6

Cancer surgeons 0.4

Insurance Payers -0.4

Strongly opposed (-3) Opposed (-1) Neutral (0) Supported (+1) Strongly supported (+3)
6
Base size n=146 (Actively considering, already purchased & decided no)
03
Proton Therapy Market Study
Method and Demographics
Who wants Proton Therapy
Benefits of Proton Therapy
Barriers to Growth
Believe in the Future
Markets
Conclusion

7
Awareness of the benefits of Proton Therapy
versus traditional Radiation Therapy
Below is a list of potential advantages of Proton Therapy versus
traditional Radiation Therapy. Which of the following were you
aware of before this study?
Lower risk of treatment induced disorders
Potential for retreatment due to lower radiation
dose in surrounding tissues
79%
Around four in five respondents were aware Proton Therapy had a
lower risk of treatment induced disorders (82%) or had the
potential for retreatment (79%) versus traditional Radiation
Therapy
82% They were least likely to be aware that Proton Therapy was lower in
cost for some indications
Benefits of Proton Therapy are well recognized even if the
respondents are not considering Proton Therapy

Potential for Dose Escalation 73% Purchased Actively Not

Decided no
Interest in Proton Therapy / using considering interested
n=29
n=72 n=45 n=34
Precise dose delivery fewer side effects than Lower risk of treatment induced
72% 89% 69% 76% 82%
IMRT disorders
Potential for retreatment due to
lower radiation dose in surrounding 86% 67% 72% 82%
tissues
Better quality of life during and after treatment 69%
Potential for Dose Escalation 82% 69% 52% 79%
Precise dose delivery fewer side
78% 56% 72% 68%
effects than IMRT
Potential for Hypofractionation 62% Better quality of life during and after
83% 64% 59% 56%
treatment
Potential for Hypofractionation 69% 49% 62% 62%
Lower cost of treatment for some
Lower cost of treatment for some indications 14% indications
19% 22% 7% 3%

Base size n=222 8

 Proton Therapy benefits requiring
further proof
Based on your knowledge of Radiation Therapy, which of the
benefits would you like further proof of Proton Therapy efficacy?
Lower cost of treatment for some indications
Better quality of life during and after treatment
Respondents were most likely to require further proof of lower cost
of treatment for some indications when considering the benefits of
Proton Therapy versus Radiation Therapy (70%)
70%
Only around a third required further proof of the potential for dose
escalation (35%) or hypofractionation (35%)
57%

Purchased / Actively Not

Decided no
Interest in Proton Therapy using considering interested
Precise dose delivery fewer side effects than IMRT 47% n=72 n=45
n=29
n=34

Lower cost of treatment for some

69% 64% 69% 86%
indications
Lower risk of treatment induced disorders 40% Better quality of life during and after
54% 51% 55% 81%
treatment

Precise dose delivery fewer side effects

49% 42% 31% 71%
Potential for retreatment due to lower radiation than IMRT
36%
dose in surrounding tissues Lower risk of treatment induced disorders 42% 44% 28% 48%
Potential for retreatment due to lower
35% 51% 38% 43%
radiation dose in surrounding tissues
Potential for Dose Escalation 35% Potential for Dose Escalation 47% 40% 17% 33%
Potential for Hypofractionation 43% 40% 24% 43%

Potential for Hypofractionation 35%

Base size n=222 9

Efficaciousness of Proton Therapy compared
to conventional Radiation Therapies
In your opinion, how efficacious do you think Proton Therapy would be in the treatment of the following
cancers compared to conventional Radiation Therapies?
EFFICACIOUS
1 Efficacy demonstrated 2 3 4 5 Efficacy NOT demonstrated Don't know NET
(1or2)
Pediatric Cancer 68 17 9 21 4 85%

Base of Skull Treatment 47 28 9 5 2 8 75%

Central Nervous System 39 26 21 3 3 8 64%

Head and Neck Cancer 27 34 22 5 7 4 62%

Prostate Cancer 20 20 26 8 20 6 40%

Larger Sarcomas 15 25 31 7 12 11 40%

Lung Cancer 10 26 30 10 15 9 36%

Lymphomas 14 18 29 10 17 12 32%

Gastrointestinal 9 21 37 9 14 11 29%

Gynecologic Cancer whole pelvis 7 13 41 11 18 10 20%

Proton Therapy was seen to be most efficacious for treating Pediatric Cancer and for Base of Skull Treatment
For lung and prostate cancers, 40 and 36% of the respondents believe that efficacy of Proton Therapy has been demonstrated.
Proton Therapy was seen as least efficacious for Gastrointestinal and Gynecological Cancer
Base size n=222 10
Efficaciousness (2009 vs. 2016)
Evolution from 2009 to 2016
90% +19% Proton Therapy is seen as more
80% +11%
efficacious in 2016 than in 2009 for
certain types of cancer
70%

60% In the 2009 study, there were 238

50% respondents with similar
+11% geographical distribution and degree
40% +24%
of familiarity with Proton Therapy
30%

20%

10%

0%
Pediatric Cancer Base of Skull Treatment Prostate Cancer Lung Cancer
2009 2016
In your opinion, how efficacious do you think Proton Therapy would be in the treatment of the following Base size 2016 n=222
11
cancers compared to conventional Radiation Therapies? % based on those who answered 1 or 2 Base size 2009 n=238
04
Proton Therapy Market Study
Method and Demographics
Who wants Proton Therapy
Benefits of Proton Therapy
Barriers to Growth
Believe in the Future
Markets
Conclusion

12
Biggest barriers to the growth of
Proton Therapy
In your opinion, what are the biggest barriers to the growth of Proton The biggest barriers impacting the
Therapy in your market?
growth of Proton Therapy were seen
More proof of efficacy 54% to be proof of efficacy (54%),
Getting adequate reimbursement
adequate reimbursement (51%) and
51%
funding (48%)
Better funding options for Proton
48%
therapy centers

Having enough patients to treat 36%

Return on Investment (19%) and
land/space availability (17%) were
Getting government authorization 32%
less of a concern
Increased referrals from general
27%
oncologists / physicians

Increased public awareness 23%

Availability of staff to support

21%
operations

Better ROI for Proton Therapy centers 19%

Land and space availability 17%

Base size n=222 13
05
Proton Therapy Market Study
Method and Demographics
Who wants Proton Therapy
Benefits of Proton Therapy
Barriers to Growth
Believe in the Future
Markets
Conclusion

14
Future of Proton Therapy
In your opinion how likely are the following?
Very unlikely Unlikely Neutral Likely Very likely
LIKELY NET
There will be more and more evidence on the clinical benefits of Proton
14 18 55 22 77%
Therapy

The availability of Proton Therapy will have a growing impact on center

3 7 17 59 15 73%
reputations

Proton Therapy will continue to grow rapidly 2 11 18 46 22 68%

Referrals from general oncologists / physicians will continue to grow sharply 2 15 28 40 14 55%

Insurance coverage for Proton Therapy treatment will improve 5 17 36 33 9 42%

Other treatment options will emerge that provide the same benefits of Proton
6 18 36 31 10 41%
therapy (high dosage, lower side effects) at a lower cost

68% of the respondents believe that Proton Therapy will continue to grow rapidly
Around three quarters felt it was likely / very likely that there would be more evidence on the clinical benefits of
Proton Therapy (77%) or the availability of Proton Therapy would have a growing impact on center reputations (73%)
Base size n=222 15
Future of Proton Therapy (by purchase group)
In your opinion how likely are the following?
All groups are confident that
Purchased / using n=72 Actively considering n=45 Decided no n=29 Not interested n=34
Proton Therapy will continue
100%
to grow and have a growing
90%
impact on center reputations,
80% even people that decided not
70% to purchase
60%

50%

40%

30%

20%

10%

0%
There will be more and more The availability of Proton Proton Therapy will continue Referrals from general
evidence on the clinical Therapy will have a growing to grow rapidly oncologists / physicians will
benefits of Proton Therapy impact on center continue to grow sharply
Base size n=180 16
reputations
Proton Therapy Solutions
Do you think one of these solutions might ever fit your
needs? Almost two-thirds were interested in a compact
system
Neither
8%
A compact system in this study is defined as a
single-room Proton Therapy system
Maybe a multi-
room system
27%

Maybe a
compact system
65%

Base size n=108 17

Proton Therapy Solutions (by purchase group)
Do you think one of these solutions might ever fit your needs?
Purchased / using n=45 Actively considering n=29 Decided no n=34
Among the group of respondents
80%
that decided no to Proton Therapy
in the past, a compact system might
70%
fit the needs in the future for 68% of
60% them
50%

40%

30%

20%

10%

0%
Maybe a multi-room system Maybe a compact system Neither

Base size n=108 18

06
Proton Therapy Market Study
Method and Demographics
Who wants Proton Therapy
Benefits of Proton Therapy
Barriers to Growth
Believe in the Future
Markets
Conclusion

19
Purchase of Proton Therapy system
From which company did you purchase your Proton Therapy
system? Around half purchased from IBA and a
IBA 49% quarter from Varian
Varian Medical Systems 23%
Other means academic or research
Mevion Medical Systems 6%
solutions developed in-house
Siemens 4%

Hitachi 3%

SHI 1%

Mitsubishi 0%

Protom International 0%

ProNova Solutions 0%

Other 11%

Don't know 3%

Base size n=72 20

07
Proton Therapy Market Study
Method and Demographics
Who wants Proton Therapy
Benefits of Proton Therapy
Barriers to Growth
Believe in the Future
Markets
Conclusion

21
Conclusion
The majority felt Proton Therapy would continue to grow rapidly

There was widespread awareness of the benefits of Proton Therapy versus traditional Radiation Therapy,
although many wanted further proof of the lower cost of treatment for certain indications

Proton Therapy is seen as more efficacious today than in 2009 for certain types of cancer

Proton Therapy was considered highly efficaciousness for certain types of cancer like Pediatric and Base of
Skull Treatment, efficaciousness for cancers like lung and prostate although many felt Proton Therapys
efficacy had not been fully demonstrated for Gastrointestinal and Gynecological Cancer

The biggest barriers impacting the growth of Proton Therapy were proof of efficacy, adequate
reimbursement and funding, whilst return on investment and space availability were less of a concern

Concerns about cost meant most were more interested in a compact system rather than a large-scale,
multi-room system

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