Comparative costs of advanced proton and photon radiation therapies: lessons from time-driven activity-based costing in head and neck cancer.

Advanced technology in the USA is, in part, responsible for driving improvements in cancer care outcomes but also steep increases in the cost of cancer care delivery [1–3]. Whether or not the US healthcare system delivers highvalue care, which is defined as the quality of health outcomes divided by the cost of achieving those outcomes, is controversial. Despite much emphasis on comparative effectiveness analyses, cost–effectiveness analyses of costly therapies, such as advanced technologies, have been under emphasized. Although the Patient Protection and Affordable Care Act has limited the role of cost analysis in the federally funded Patient-Centered Outcomes Research Institute, given the controversy and fear of rationing of healthcare services [4], successful transformation from volume to value will require patients, providers and payors to understand the comparative effectiveness and cost–effectiveness of competing technological treatment modalities.