KEY POINTS
- The systematic review searched four databases and health technology assessment literature for original particle therapy costing studies published from January 2000 to October 2025. Only 12 studies met the eligibility criteria from 2,334 identified records.
- Costing approaches varied substantially: six studies used traditional costing, three used time-driven activity-based costing, and one each used activity-based costing, micro-costing, or discounted cash-flow analysis.
- Studies differed in included cost items, allocation bases, analytical perspective, and reported cost objects, which ranged from cost per fraction to cost per patient or treatment course.
- Reported particle therapy costs varied widely and could not be reliably compared because of differences in currencies, price years, fractionation schedules, clinical settings, and underlying assumptions.
- The authors recommend transparent reporting of direct and indirect costs and identify time-driven activity-based costing as the preferred approach for complex, evolving radiotherapy environments, while noting that community consensus is still required.
CLINICAL TAKEAWAY
Current particle therapy cost estimates are too methodologically inconsistent to support straightforward comparisons between centres, countries, or treatment modalities. Standardized costing frameworks are needed before economic evaluations and reimbursement decisions can be interpreted reliably; the recommendations proposed here are a foundation rather than an established guideline.