Direct costs of radiotherapy for rectal cancer: a microcosting study

Abstract

BackgroundRadiotherapy 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.MethodsMicrocosting 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.ResultsRadiotherapy 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).ConclusionsTraditional 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.

The changes of radiotherapy in Lithuania: infrastructure, utilization rate, and cost

“…In this survey, we calculated the average RT treatment costs in RT centres per calendar year. Our result is much lower than the average cost calculated by other studies, e. g. Ploquin and Dunscombe performed cost metaanalysis in which the mean normalized cost in 2005 was EUR 3.239 (14); in the recent Ireland study, the cost of traditional RT for rectal cancer in 2012 was EUR 3.609 (24). Certainly, there are calculation errors due to methodological differences, but we can see common tendencies and make a comparison and come to preliminary conclusions.…”

Neoadjuvant long‐course chemoradiation remains strongly favored over short‐course radiotherapy by radiation oncologists in the United States

“…Between 2007 and 2010 in Sweden, approximately 80% of patients with rectal cancer undergoing preoperative RT received SC-RT. 18 To the best of our knowledge, cost analyses of RT for rectal cancer have not been performed in the United States. 15 Use of SC-RT in the United Kingdom and Canada remains less common than in these northern European countries, but still exceeds the low rates reported in the United States.…”

“…9,16,17 An analysis of cost for RT of rectal cancer in Ireland calculated the average RT costs to be e2080 and e3609, respectively, for SC-RT and long-course RT courses in 2012. 18 To the best of our knowledge, cost analyses of RT for rectal cancer have not been performed in the United States. However, similar cost differences would be expected, and the omission of neoadjuvant chemotherapy in SC-RT would likely contribute to an even greater divergence in costs between SC-RT and LC-CRT.…”

Neoadjuvant treatment for rectal cancer—A value‐based proposition

“…However, because LC CRT is the dominant treatment strategy in the US, there have been no domestic comparative studies of the costs associated with LC and SC. However, there are recent data from Europe suggesting 50% higher costs for LC over SC [23]. In the context of existing and evolving data to suggest oncologic outcomes after SC XRT compare favorably to LC CRT and given the ongoing emphasis on identifying cost-effective treatments and management modalities, future work to delineate provider biases and/or other reasons why SC XRT is not more commonly utilized in the US will be needed.…”