ABSTRACT
BACKGROUND: The Health Economics in Radiation Oncology (ESTRO-HERO) project aims to provide a knowledge base for health economics in European radiotherapy. A cost-accounting model, providing data on national resource requirements and costs of external beam radiotherapy (EBRT), was developed. MATERIALS AND METHODS: Time-driven activity-based costing (TD-ABC) was applied from the healthcare provider perspective at national level. TD-ABC allocates resource costs to treatment courses through the activities performed, based on time estimates. RESULTS: The model is structured in three layers. The central layer, EBRT-Core, accounts for EBRT care-pathway activities and follows TD-ABC allocation principles. Activities supporting radiation oncology (RO) (RO-Support) and multidisciplinary oncology (Beyond-EBRT) follow standard allocation principles. To demonstrate the model's capabilities, a dataset was constructed for the hypothetical country Europalia, based on published evidence on resources and treatments, whereas time estimates were expert opinions. Applying the TD-ABC model to this example, treatment delivery activities represent 68.4% of the costs; treatment preparation 31.6%. The cost per course shows large variation for different indications, techniques, and fractionation schedules, ranging between 838 and 7193. Resource utilization was estimated to be within the available capacity. Scenario analyses on changes in fractionation and treatment complexity are presented. The ESTRO-HERO TD-ABC tool can model EBRT costs and resource requirements. While the Europalia example illustrates its potential, the results cannot be generalized nor used as a proxy for national evidence. Only real-world data, tailored to the specificities of individual countries, will support National Radiation Oncology Societies with investment planning and access to innovative radiotherapy.
Subject(s)
Models, Economic , Neoplasms/radiotherapy , Radiation Oncology/economics , Radiotherapy/economics , Costs and Cost Analysis , Data Collection , European Union , Health Resources/economics , Humans , Neoplasms/economics , Radiotherapy/methodsABSTRACT
BACKGROUND AND PURPOSE: Non-small cell lung cancer (NSCLC) tumours are mostly heterogeneous. We hypothesized that areas within the tumour with a high pre-radiation (18)F-deoxyglucose (FDG) uptake, could identify residual metabolic-active areas, ultimately enabling selective-boosting of tumour sub-volumes. MATERIAL AND METHODS: Fifty-five patients with inoperable stage I-III NSCLC treated with chemo-radiation or with radiotherapy alone were included. For each patient one pre-radiotherapy and one post-radiotherapy FDG-PET-CT scans were available. Twenty-two patients showing persistent FDG uptake in the primary tumour after radiotherapy were analyzed. Overlap fractions (OFs) were calculated between standardized uptake value (SUV) threshold-based auto-delineations on the pre- and post-radiotherapy scan. RESULTS: Patients with residual metabolic-active areas within the tumour had a significantly worse survival compared to individuals with a complete metabolic response (p=0.002). The residual metabolic-active areas within the tumour largely corresponded (OF>70%) with the 50%SUV high FDG uptake area of the pre-radiotherapy scan. The hotspot within the residual area (90%SUV) was completely within the GTV (OF=100%), and had a high overlap with the pre-radiotherapy 50%SUV threshold (OF>84%). CONCLUSIONS: The location of residual metabolic-active areas within the primary tumour after therapy corresponded with the original high FDG uptake areas pre-radiotherapy. Therefore, a single pre-treatment FDG-PET-CT scan allows for the identification of residual metabolic-active areas.