ArticleThe oncologist2011
When to wait for more evidence? Real options analysis in proton therapy.
Article in The oncologist, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- A systematic review of the applications of the real option value of medical technologies in oncology.Journal of managed care & specialty pharmacy · 2025Pooled it
- Coverage with evidence development for medical devices in Europe: Can practice meet theory?Health economics · 2022Article
- Coverage with evidence development schemes for medical devices in Europe: characteristics and challenges.The European journal of health economics : HEPAC : health economics in prevention and care · 2021Article
- Hospital Investment Decisions in Healthcare 4.0 Technologies: Scoping Review and Framework for Exploring Challenges, Trends, and Research Directions.Journal of medical Internet research · 2021Article
- Decision analytic modeling for the economic analysis of proton radiotherapy for non-small cell lung cancer.Translational lung cancer research · 2018Article
- Consensus Statement on Proton Therapy in Early-Stage and Locally Advanced Non-Small Cell Lung Cancer.International journal of radiation oncology, biology, physics · 2016Review
- Use of Value of Information in Healthcare Decision Making: Exploring Multiple Perspectives.PharmacoEconomics · 2016Article
- Variations in Proton Therapy Coverage in the State of Texas: Defining Medical Necessity for a Safe and Effective Treatment.International journal of particle therapy · 2016Article
- Dosimetric Comparison and Potential for Improved Clinical Outcomes of Paediatric CNS Patients Treated with Protons or IMRT.Cancers · 2015Review
- Sample Size Estimation for Non-Inferiority Trials: Frequentist Approach versus Decision Theory Approach.PloS one · 2015Article
- Article
- Healthy decisions: towards uncertainty tolerance in healthcare policy.PharmacoEconomics · 2015Article
- Making investments in medical technology: time to get real about real options.The oncologist · 2011Article
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTrends suggest that cancer spending growth will accelerate. One method for controlling costs is to examine whether the benefits of new technologies are worth the extra costs. However, especially new and emerging technologies are often more costly, while limited clinical evidence of superiority is available. In that situation it is often unclear whether to adopt the new technology now, with the risk of investing in a suboptimal therapy, or to wait for more evidence, with the risk of withholding patients their optimal treatment. This trade-off is especially difficult when it is costly to reverse the decision to adopt a technology, as is the case for proton therapy. Real options analysis, a technique originating from financial economics, assists in making this trade-off.
methodsWe examined whether to adopt proton therapy, as compared to stereotactic body radiotherapy, in the treatment of inoperable stage I non-small cell lung cancer. Three options are available: adopt without further research; adopt and undertake a trial; or delay adoption and undertake a trial. The decision depends on the expected net gain of each option, calculated by subtracting its total costs from its expected benefits.
resultsIn The Netherlands, adopt and trial was found to be the preferred option, with an optimal sample size of 200 patients. Increase of treatment costs abroad and costs of reversal altered the preferred option.
conclusionWe have shown that real options analysis provides a transparent method of weighing the costs and benefits of adopting and/or further researching new and expensive technologies.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.