Kesteloot K, Lievens Y, van der Schueren E
Center for Health Services and Nursing Research, Department of Applied Economics, KU, Leuven, Belgium.
Radiother Oncol. 2000 Jun;55(3):251-62. doi: 10.1016/s0167-8140(99)00034-1.
Escalating health care expenses urge governments towards cost containment. More accurate data on the precise costs of health care interventions are needed. We performed an aggregate cost calculation of radiation therapy departments and treatments and discussed the different cost components.
The costs of a radiotherapy department were estimated, based on accreditation norms for radiotherapy departments set forth in the Belgian legislation.
The major cost components of radiotherapy are the cost of buildings and facilities, equipment, medical and non-medical staff, materials and overhead. They respectively represent around 3, 30, 50, 4 and 13% of the total costs, irrespective of the department size. The average cost per patient lowers with increasing department size and optimal utilization of resources. Radiotherapy treatment costs vary in a stepwise fashion: minor variations of patient load do not affect the cost picture significantly due to a small impact of variable costs. With larger increases in patient load however, additional equipment and/or staff will become necessary, resulting in additional semi-fixed costs and an important increase in costs. A sensitivity analysis of these two major cost inputs shows that a decrease in total costs of 12-13% can be obtained by assuming a 20% less than full time availability of personnel; that due to evolving seniority levels, the annual increase in wage costs is estimated to be more than 1%; that by changing the clinical life-time of buildings and equipment with unchanged interest rate, a 5% reduction of total costs and cost per patient can be calculated. More sophisticated equipment will not have a very large impact on the cost (+/-4000 BEF/patient), provided that the additional equipment is adapted to the size of the department. That the recommendations we used, based on the Belgian legislation, are not outrageous is shown by replacing them by the USA Blue book recommendations. Depending on the department size, costs in our model would then increase with 14-36%.
We showed that cost information can be used to analyze the precise financial consequences of changes in routine clinical practice in radiotherapy. Comparing the cost data with the prevailing reimbursement may reveal inconsistencies and stimulate to develop improved financing systems.
不断攀升的医疗保健费用促使政府采取成本控制措施。需要更准确的关于医疗保健干预确切成本的数据。我们对放射治疗科室及治疗进行了总成本计算，并讨论了不同的成本构成要素。
根据比利时立法规定的放射治疗科室认证规范，估算了一个放射治疗科室的成本。
放射治疗的主要成本构成要素为建筑与设施成本、设备成本、医护及非医护人员成本、材料成本和间接费用。无论科室规模大小，它们分别约占总成本的3%、30%、50%、4%和13%。随着科室规模的扩大和资源的优化利用，每位患者的平均成本会降低。放射治疗的成本呈阶梯式变化：由于可变成本影响较小，患者数量的微小变化对成本情况影响不大。然而，随着患者数量大幅增加，就需要额外的设备和/或人员，从而导致额外的半固定成本，并使成本大幅增加。对这两个主要成本投入进行的敏感性分析表明，假设人员全职工作时间减少20%，总成本可降低12 - 13%；由于资历水平的变化，工资成本预计每年增长超过1%；在利率不变的情况下，通过改变建筑和设备的临床使用期限，可计算出总成本和每位患者的成本降低5%。只要额外设备适合科室规模，更先进的设备对成本的影响不会很大（每位患者±4000比利时法郎）。用美国蓝皮书建议取代我们基于比利时立法使用的建议，结果表明我们的建议并非离谱。根据科室规模不同，我们模型中的成本将增加14 - 36%。
我们表明成本信息可用于分析放射治疗常规临床实践变化的确切财务后果。将成本数据与现行报销情况进行比较可能会发现不一致之处，并促使开发更完善的融资系统。
