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Direct costs of radiotherapy for rectal cancer: a microcosting study.

Hanly P, Céilleachair AÓ, Skally M, O'Neill C, Sharp L - BMC Health Serv Res (2015)

Bottom Line: Sensitivity analyses were performed.By simultaneously varying treatment time, capacity utilization rates and linear accelerator staff numbers, the base cost fell by 20% for 5-fractions: (€1,660) and 35% for 25-fractions: (€2,354).Moreover, significant savings may be achievable through service organization and provision changes.

View Article: PubMed Central - PubMed

Affiliation: School of Business, National College of Ireland, Dublin, Ireland. paul.hanly@ncirl.ie.

ABSTRACT

Background: Radiotherapy provides significant benefits in terms of reducing risk of local recurrence and death from rectal cancer. Despite this, up-to-date cost estimates for radiotherapy are lacking, potentially inhibiting policy and decision-making. Our objective was to generate an up-to-date estimate of the cost of traditional radiotherapy for rectal cancer and model the impact of a range of potential efficiency improvements.

Methods: Microcosting methods were used to estimate total direct radiotherapy costs for long- (assumed at 45-50 Gy in 25 daily fractions over a 5 week period) and short-courses (assumed at 25 Gy in 5 daily fractions over a one week period). Following interviews and on-site visits to radiotherapy departments in two designated cancer centers, a radiotherapy care pathway for a typical rectal cancer patient was developed. Total direct costs were derived by applying fixed and variable unit costs to resource use within each care phase. Costs included labor, capital, consumables and overheads. Sensitivity analyses were performed.

Results: Radiotherapy treatment was estimated to cost between €2,080 (5-fraction course) and €3,609 (25-fraction course) for an average patient in 2012. Costs were highest in the treatment planning phase for the short-course (€1,217; 58% of total costs), but highest in the radiation treatment phase for the long-course (€1,974: 60% of total costs). By simultaneously varying treatment time, capacity utilization rates and linear accelerator staff numbers, the base cost fell by 20% for 5-fractions: (€1,660) and 35% for 25-fractions: (€2,354).

Conclusions: Traditional radiotherapy for rectal cancer is relatively inexpensive. Moreover, significant savings may be achievable through service organization and provision changes. These results suggest that a strong economic argument can be made for expanding the use of radiotherapy in rectal cancer treatment.

No MeSH data available.


Related in: MedlinePlus

Sensitivity analysis of key radiotherapy cost drivers: total costs per course and percentage deviation from base case estimates (in brackets), by number of fractions per course (2012€). a. variations in treatment time (Treatment time refers to the time taken per radiotherapy session per procedure. 15 minutes relates to current practice). b. variations in capacity utilization (Capacity utilization refers to the time both labor and capital operate in the radiotherapy department on a given day. 100% relates to current working hours). c. variations in staff numbers (Staff numbers refers to the number of personnel per linear accelerator per procedure. Four staff members per linear accelerator relates to current practice). d. variations in overheads (Overheads refers to the costs of accommodation, utilities (light, heat and telephone), support and back-office staff and training for radiotherapy. 40% relates to Irish current recommendations on the costing of overheads in relation to direct salary costs).
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Fig1: Sensitivity analysis of key radiotherapy cost drivers: total costs per course and percentage deviation from base case estimates (in brackets), by number of fractions per course (2012€). a. variations in treatment time (Treatment time refers to the time taken per radiotherapy session per procedure. 15 minutes relates to current practice). b. variations in capacity utilization (Capacity utilization refers to the time both labor and capital operate in the radiotherapy department on a given day. 100% relates to current working hours). c. variations in staff numbers (Staff numbers refers to the number of personnel per linear accelerator per procedure. Four staff members per linear accelerator relates to current practice). d. variations in overheads (Overheads refers to the costs of accommodation, utilities (light, heat and telephone), support and back-office staff and training for radiotherapy. 40% relates to Irish current recommendations on the costing of overheads in relation to direct salary costs).

Mentions: Varying treatment time from 15 minutes (base case) to 10 minutes caused the total cost per course to fall by 6% (5 fractions) - 18% (25 fractions); when it was increased to 20 minutes, the total cost rose by between 6% and 18% (Figure 1a). Changing capacity utilization from 100% to 80% caused the base case estimate to increase by 16%-19%; increasing utilization to 125% reduced the total cost by 13-15% across courses (Figure 1b). The total radiotherapy cost was relatively insensitive to changes in linear accelerator staff numbers and overhead costs (Figure 1c and d).Figure 1


Direct costs of radiotherapy for rectal cancer: a microcosting study.

Hanly P, Céilleachair AÓ, Skally M, O'Neill C, Sharp L - BMC Health Serv Res (2015)

Sensitivity analysis of key radiotherapy cost drivers: total costs per course and percentage deviation from base case estimates (in brackets), by number of fractions per course (2012€). a. variations in treatment time (Treatment time refers to the time taken per radiotherapy session per procedure. 15 minutes relates to current practice). b. variations in capacity utilization (Capacity utilization refers to the time both labor and capital operate in the radiotherapy department on a given day. 100% relates to current working hours). c. variations in staff numbers (Staff numbers refers to the number of personnel per linear accelerator per procedure. Four staff members per linear accelerator relates to current practice). d. variations in overheads (Overheads refers to the costs of accommodation, utilities (light, heat and telephone), support and back-office staff and training for radiotherapy. 40% relates to Irish current recommendations on the costing of overheads in relation to direct salary costs).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4494796&req=5

Fig1: Sensitivity analysis of key radiotherapy cost drivers: total costs per course and percentage deviation from base case estimates (in brackets), by number of fractions per course (2012€). a. variations in treatment time (Treatment time refers to the time taken per radiotherapy session per procedure. 15 minutes relates to current practice). b. variations in capacity utilization (Capacity utilization refers to the time both labor and capital operate in the radiotherapy department on a given day. 100% relates to current working hours). c. variations in staff numbers (Staff numbers refers to the number of personnel per linear accelerator per procedure. Four staff members per linear accelerator relates to current practice). d. variations in overheads (Overheads refers to the costs of accommodation, utilities (light, heat and telephone), support and back-office staff and training for radiotherapy. 40% relates to Irish current recommendations on the costing of overheads in relation to direct salary costs).
Mentions: Varying treatment time from 15 minutes (base case) to 10 minutes caused the total cost per course to fall by 6% (5 fractions) - 18% (25 fractions); when it was increased to 20 minutes, the total cost rose by between 6% and 18% (Figure 1a). Changing capacity utilization from 100% to 80% caused the base case estimate to increase by 16%-19%; increasing utilization to 125% reduced the total cost by 13-15% across courses (Figure 1b). The total radiotherapy cost was relatively insensitive to changes in linear accelerator staff numbers and overhead costs (Figure 1c and d).Figure 1

Bottom Line: Sensitivity analyses were performed.By simultaneously varying treatment time, capacity utilization rates and linear accelerator staff numbers, the base cost fell by 20% for 5-fractions: (€1,660) and 35% for 25-fractions: (€2,354).Moreover, significant savings may be achievable through service organization and provision changes.

View Article: PubMed Central - PubMed

Affiliation: School of Business, National College of Ireland, Dublin, Ireland. paul.hanly@ncirl.ie.

ABSTRACT

Background: Radiotherapy provides significant benefits in terms of reducing risk of local recurrence and death from rectal cancer. Despite this, up-to-date cost estimates for radiotherapy are lacking, potentially inhibiting policy and decision-making. Our objective was to generate an up-to-date estimate of the cost of traditional radiotherapy for rectal cancer and model the impact of a range of potential efficiency improvements.

Methods: Microcosting methods were used to estimate total direct radiotherapy costs for long- (assumed at 45-50 Gy in 25 daily fractions over a 5 week period) and short-courses (assumed at 25 Gy in 5 daily fractions over a one week period). Following interviews and on-site visits to radiotherapy departments in two designated cancer centers, a radiotherapy care pathway for a typical rectal cancer patient was developed. Total direct costs were derived by applying fixed and variable unit costs to resource use within each care phase. Costs included labor, capital, consumables and overheads. Sensitivity analyses were performed.

Results: Radiotherapy treatment was estimated to cost between €2,080 (5-fraction course) and €3,609 (25-fraction course) for an average patient in 2012. Costs were highest in the treatment planning phase for the short-course (€1,217; 58% of total costs), but highest in the radiation treatment phase for the long-course (€1,974: 60% of total costs). By simultaneously varying treatment time, capacity utilization rates and linear accelerator staff numbers, the base cost fell by 20% for 5-fractions: (€1,660) and 35% for 25-fractions: (€2,354).

Conclusions: Traditional radiotherapy for rectal cancer is relatively inexpensive. Moreover, significant savings may be achievable through service organization and provision changes. These results suggest that a strong economic argument can be made for expanding the use of radiotherapy in rectal cancer treatment.

No MeSH data available.


Related in: MedlinePlus