[Economic assessment of pulsed dose-rate (PDR) brachytherapy with optimized dose distribution for cervix carcinoma]. / Evaluation économique de la curiethérapie de débit pulsé gynécologique (PDR) avec optimisation de la dose pour les cancers du col utérin.

PURPOSE: Our study aims at evaluating the cost of pulsed dose-rate (PDR) brachytherapy with optimized dose distribution versus traditional treatments (iridium wires, cesium, non-optimized PDR). Issues surrounding reimbursement were also explored. MATERIALS AND METHODS: This prospective, multicentre, non-randomised study conducted in the framework of a project entitled "Support Program for Costly Diagnostic and Therapeutic Innovations" involved 21 hospitals. Patients with cervix carcinoma received either classical brachytherapy or the innovation. The direct medical costs of staff and equipment, as well as the costs of radioactive sources, consumables and building renovation were evaluated from a hospital point of view using a microcosting approach. Subsequent costs per brachytherapy were compared between the four strategies. RESULTS: The economic study included 463 patients over two years. The main resources categories associated with PDR brachytherapy (whether optimized or not) were radioactive sources (1053euro) and source projectors (735euro). Optimized PDR induced higher cost of imagery and dosimetry (respectively 130euro and 367euro) than non-optimized PDR (47euro and 75euro). Extra costs of innovation over the less costly strategy (iridium wires) reached more than 2100euro per treatment, but could be reduced by half in the hypothesis of 40 patients treated per year (instead of 24 in the study). CONCLUSION: Aside from staff, imaging and dosimetry, the current hospital reimbursements largely underestimated the cost of innovation related to equipment and sources.

[The cost of respiration-gated radiotherapy in the framework of a clinical research programme "STIC"]. / Evaluation du coût de la radiothérapie asservie à la respiration dans le cadre d'un projet Stic.

PURPOSE: Our study aims to evaluate the impact of the implementation of respiratory gating (RG) on the production cost of radiotherapy, as compared to conformational radiotherapy without RG (comparator) in patients with lung or breast cancers. Issues surrounding reimbursement were also explored. MATERIALS AND METHODS: A prospective, multicenter, non-randomised study was conducted in the framework of a project entitled "Support Program for Costly Diagnostic and Therapeutic Innovations". Of the 20 hospitals involved in the clinical study, eight reference centers participated to the medico-economic study evaluating the costs of staff and equipment, as well as the costs of maintenance and consumables. RESULTS: Three hundred and sixty-five patients were enrolled over two years in the economic study, corresponding to 197 radiotherapy treatments without RG and 168 with RG. Patients treated during the learning phase (n=27) were excluded from the comparison with the control group. The use of RG in routine practice induced a cost increase of respectively euro1256 and euro996 per treatment for lung and breast cancer patients treated with breath-hold techniques, versus euro1807 and euro1510 for lung and breast cancer patients treated with synchronized gating techniques. Overcosts were mainly due to extra working time of medical staff and medical technicians and to extra use of equipment during treatment sessions. CONCLUSION: The results of the full cost estimation suggested that medical reimbursements largely underestimate the costs related to innovation.

[Impact of FDG-PET on radiation therapy: economic results of a STIC study]. / L'apport de la tomographie par émission de positons au FDG pour la radiothérapie: résultats de l'évaluation économique du Stic "TEP et radiothérapie".

The aim of this study is to assess the effects of Positron Emission Tomography (PET) associated with computed tomography (CT) on resource allocation (costs and savings) of the following treatment in radiotherapy for non small cell lung cancers (NSCLC) and Hodgkin's diseases. A national prospective study was conducted in nine hospitals. Two treatment decisions made on the basis of CT only or on PET associated with, were compared in a before-after design. The direct medical cost of using PET was assessed by micro-costing. The costs of new exams and the costs and savings associated with changes in the chosen treatment were calculated on the basis of reimbursement rates. The economic study was conducted over 2 years and included 209 patients (97 patients with Hodgkin's disease and 112 with NSCLC). The mean cost of using PET, corresponding to an extra cost, was approximately 800 euro (50% for the radionuclide FDG). Radiotherapy treatments were modified for only 10% of patients with Hodgkin's disease with a minor impact on treatment costs versus 40% of patients with lung cancer with a reduction in mean treatment cost of more than 500 euro.

[Image-guided radiotherapy]. / Radiothérapie guidée par l'image.

Recent advances in radiation oncology are based on improvement in dose distribution thanks to IMRT and improvement in target definition through new diagnostic imaging such as spectroscopic or functional MRI or PET. However, anatomic variations may occur during treatment decreasing the benefit of such optimization. Image-guided radiotherapy reduces geometric uncertainties occurring during treatment and therefore should reduce dose delivered to healthy tissues and enable dose escalation to enhance tumour control. However, IGRT experience is still limited, while a wide panel of IGRT modalities is available. A strong quality control is required for safety and proper evaluation of the clinical benefit of IGRT combined or not with IMRT.