European Society for Radiotherapy and Oncology and Ghent University, Belgium.
University of Lyon, Centre Léon Bérard, Lyon, France.
Radiother Oncol. 2019 Sep;138:187-194. doi: 10.1016/j.radonc.2019.06.015. Epub 2019 Jul 15.
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.
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.
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.
放射肿瘤学中的健康经济学（ESTRO-HERO）项目旨在为欧洲放射治疗中的健康经济学提供一个知识库。开发了一种成本核算模型，提供了关于国家资源需求和外照射放射治疗（EBRT）成本的数据。
从医疗保健提供者的角度，在国家层面应用时间驱动的作业成本法（TD-ABC）。TD-ABC 通过基于时间估计的治疗课程所执行的活动，将资源成本分配给治疗课程。
该模型分为三层。核心层 EBRT-Core 核算 EBRT 护理路径活动，并遵循 TD-ABC 分配原则。支持放射肿瘤学（RO）的活动（RO-Support）和多学科肿瘤学（Beyond-EBRT）遵循标准分配原则。为了展示模型的功能，根据资源和治疗的已发表证据，为假设的国家 Europalia 构建了一个数据集，而时间估计则是专家意见。将 TD-ABC 模型应用于该示例，治疗提供活动占成本的 68.4%；治疗准备活动占 31.6%。每个疗程的成本因不同的适应症、技术和分割方案而有很大差异，范围在 838 欧元至 7193 欧元之间。资源利用被估计在可用能力范围内。还介绍了关于分割和治疗复杂性变化的情景分析。ESTRO-HERO TD-ABC 工具可以模拟 EBRT 成本和资源需求。虽然 Europalia 示例说明了其潜力，但结果不能推广，也不能用作国家证据的替代。只有针对个别国家特点量身定制的实际数据，才能支持国家放射肿瘤学会进行投资规划和获得创新放射治疗。
