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Access to proton beam therapy (PBT) is limited in many parts of the world including in the Middle East. We modelled the demand for PBT services and the economic cost of establishing PBT centres in Middle Eastern countries.

Incidence rates for cancers in Kuwait, Egypt, Jordan and Saudi Arabia were extracted from GLOBOCAN and national cancer registries. Findings from a previous study (Burnet et al. Br J Radiol. 2022) were used to estimate demand for PBT services. We assumed that 50% of cancer patients will receive radiotherapy and of these, 60% will be treated with curative-intent. We assumed that all paediatric cancers treated with curative-intent radiotherapy (excluding leukaemia) would benefit from PBT due to reduced growth impairment. We utilised the estimated benefit percentage as per Burnet et al. for reduced toxicity as the sole mechanism of benefit from PBT for adult cancers. The price of a 2-4 gantry PBT centre with a maximum treatment capacity of 1,000-1,200 patients annually was calculated using an average figure from 9 developed countries ($127m). We assumed that 60% of this cost would be fixed representing equipment while the remainder were corrected for purchasing price parity in each country since they represent costs related to infrastructure and labour.

The percentage of paediatric cancers is more than 6 times higher in Middle Eastern countries (mean for 4 countries: 3.14%; Kuwait: 2.69%, Jordan: 2.9%, Egypt: 3.12% and Saudi Arabia: 3.86%) compared to 4 developed countries (mean: 0.51% in UK, USA, France and Australia). The number of paediatric cancer patients who would benefit from PBT annually in Middle Eastern countries is: Kuwait (N=34), Jordan (N=139), Egypt (N=1,912) and Saudi Arabia (N=384). The number (and percentage) of additional adult cancer patients treated with curative-intent radiotherapy who would benefit from PBT annually in Middle Eastern countries was: Kuwait: 98 (10.55%), Jordan: 395 (13.3%), Egypt: 2,756 (11.1%) and Saudi Arabia: 643 (10.55%); Table 1 and Figure 1. The modelled estimated total cost of a 2-4 gantry PBT facility in Middle Eastern countries was: Kuwait $105m, Jordan $99m, Egypt $89m and Saudi Arabia $101m. Therefore, the cost of establishing a PBT centre would represent 0.093% of Kuwait’s GDP, 0.3% of Jordan’s GDP, 0.035% of Egypt’s GDP and 0.018% of Saudi Arabia’s GDP (mean for 4 countries: 0.11%). This is 27 times more than the average cost as a share of GDP in 4 developed countries (UK, USA, France and Australia). Assuming a lifetime of 20 years for the PBT centre, the cost of PBT per patient in Middle Eastern countries is: Kuwait: $51,746, Jordan: $31,589, Egypt: $25,936 and Saudi Arabia: $43,823.

Table 1

Figure 1

We report important information on the demand for PBT services and the economic costs of establishing PBT centres in Middle Eastern countries. Our findings could guide future healthcare policy planning in our region.