Medical Physics Department, Greater Poland Cancer Centre, Poznan, Poland.
Phys Med. 2009 Dec;25(4):201-6. doi: 10.1016/j.ejmp.2009.02.001. Epub 2009 Mar 16.
To present the methodology for the evaluation of cost-effectiveness of the quality assurance protocol modifications associated with increasing demands on accuracy and reliability in radiotherapy and to present results on cost-effectiveness of in-vivo dosimetry as the chosen example of a technical procedure.
In-vivo dosimetry was used as an example of a quality assurance procedure, whose modifications have an impact on several procedures in the QA system and thus on the cost of radiotherapy. An analysis of 6864 patients, treated between 2001 and 2005 for tumours in the head and neck, breast, pelvis, or lung, was performed. The quality of radiotherapy was expressed as the accuracy of dose delivery and the cost was estimated from labour, equipment and materials.
Modifications implemented in the quality assurance protocol have gradually improved the quality of irradiation. Mean deviations between measured and calculated doses, recorded for several groups of treatment sites, were reduced from -1.5% to 0.5%, 3.4% to 1.4%, 3.9% to 0.1% and -2.1% to 1.8% for head and neck, breast, pelvis and lung respectively. The standard deviations of the measured values decreased also consistently. Total monthly cost in radiotherapy (related to in-vivo dosimetry) increased from euro 4376 to euro 10,696 while the unitary cost of radiotherapy procedures remained at the same level. The predominant cost component of in-vivo dosimetry was labour, limited at first to physics staff and later extended to quality assurance personnel and technicians.
The application of the presented methodology revealed cost-effectiveness relationships in tested technical procedures.
介绍与提高放射治疗准确性和可靠性要求相关的质量保证协议修改的成本效益评估方法，并介绍体内剂量学作为技术程序选择实例的成本效益。
将体内剂量学用作质量保证程序的示例，其修改对 QA 系统中的几个程序产生影响，从而影响放射治疗的成本。对 2001 年至 2005 年间治疗头颈部、乳房、骨盆或肺部肿瘤的 6864 例患者进行了分析。放射治疗质量表示为剂量输送的准确性，成本由劳动力、设备和材料估算。
质量保证协议中实施的修改逐渐提高了照射质量。记录的几个治疗部位组的测量剂量与计算剂量之间的平均偏差从-1.5%降至 0.5%、3.4%降至 1.4%、3.9%降至 0.1%和-2.1%降至 1.8%，分别为头颈部、乳房、骨盆和肺部。测量值的标准差也一致下降。放射治疗（与体内剂量学相关）的每月总成本从 4376 欧元增加到 10696 欧元，而放射治疗程序的单位成本保持不变。体内剂量学的主要成本构成是劳动力，最初仅限于物理人员，后来扩展到质量保证人员和技术人员。
所提出的方法的应用揭示了测试技术程序中的成本效益关系。
