Proton Beam Therapy
Proton beam therapy is a form of radiotherapy where the beam can be very precisely targeted on a tumour. The accuracy of proton beam therapy means that it is possible to give lower radiation doses and it is possible to avoid damaging critical tissues. Proton beam therapy is particularly useful for treating children and young people with brain tumours.
The UK has one low energy proton beam unit at The Clatterbridge Foundation Trust, but currently does not have a high energy unit. Since 2008, patients who would benefit from proton beam therapy have been sent to facilities abroad  (mostly Florida and Oklahoma but some to Switzerland ). The Department of Health say that the average cost to send a patient to the commercial facilities in the US is approximately £110,000 (or a QALY of £41,464).
The Outline Business Case  (OBC) from the Department of Health for the new proton beam therapy units estimates that the minimum number of NHS patients to be commissioned for the UK (England and the devolved nations) is 1,487. The OBC says that 5% of the capacity should be available for research (71 patients) indicating that the commissioned capacity should be 1,561. (If the Republic of Ireland is included then these figures are 1,595, and 1,664 including research.) If a proton beam unit is run at maximum capacity it is capable of treating 750 patients a year, so the country needs a minimum of two units.
The OBC covered three scoping options: continue to send patients to overseas facilities; utilise the private sector to provide capacity in England; and NHS provision. The first option was rejected because of uncertainty that the international capacity and price would be sustained at current levels. The OBC states that due to high costs of market entry there was no commercial interest, and the OBC also rejected PFI as a funding option for a similar reason. This meant that only the third option, NHS provision, was viable.
To meet this option the OBC gave two suitable cases: either two centres or three centres. A two site option would be lower capital cost, but two sites at a maximum capacity of 750 each would only just meet the requirement. The three site plan was rejected because, (taking a central estimate of 675 patients a year per site), there would be over capacity of 538 patients a year compared to the estimation of 1,487 annual UK indications. The DH regarded it as being a significant risk to try and fill the three site excess capacity with patients from overseas. The final plan to have two sites means that every year there will be capacity for between 1,200 and 1,500 patients a year leaving little spare capacity above the 1,487 needed for NHS patients.
The OBC says that the cost per patient for two sites would be £39,500 (cost per QALY, £19,187) representing a large savings on the current situation. The cost of installing a proton beam unit is large: the OBC estimates  that the cost of providing a single proton beam therapy unit is £150m and the annual cost (including finance costs) would be £25m a year.
In April 2012 the Department of Health announced that the government would support the two site option with one unit at The Christie Hospital and the other at University College London Hospital . However, the press release indicates that the government would provide funding of £250, so there is a possible shortfall compared to the estimated cost of £150m per unit. Board papers from The Christie in April 2012  indicate that the government will require that £10m per site must come from charitable funds:
Proton update – IM [Ian Moston, Director of finance & business development] reported on ongoing discussions with the DH and felt an announcement on the preferred sites was imminent. He explained the DH has approached both potential sites to explore the option of a £10m per site charitable contribution. He envisaged a national fundraising campaign to compliment local fundraising.
 p172 www.christie.nhs.uk/media/282877/Public_final_300412.pdf