阴道残端近距离放疗中减少分次次数的经济影响：直接成本分析
Economic impact of decreasing the fraction number in vaginal cuff brachytherapy: A direct cost analysis.
作者信息
Zhang Yaowen, Rovirosa Angeles, Ascaso Carlos, Herreros Antonio, Torne Aureli, Li Yan, Biete Albert, Sánchez Joan
机构信息
Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Radiation Oncology Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain.
Fonaments Clinics Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Radiation Oncology Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain; Gynaecological Cancer Unit, Gynaecology and Obtetrics Department, Hospital Clinic Universitari Barcelona, Barcelona, Spain.
出版信息
Brachytherapy. 2020 Jan-Feb;19(1):60-65. doi: 10.1016/j.brachy.2019.09.004. Epub 2019 Oct 3.
PURPOSE
The purpose of this study was to analyze the direct economic impact of two vaginal cuff brachytherapy (VBT) schedules in postoperative endometrial carcinoma (PEC) with similar vaginal control and toxicity results.
MATERIALS AND METHODS
From 2006 to 2015, 397 PEC patients (p) were treated with VBT: mean 40p/year, 67.5% received external beam radiotherapy (EBRT)+VBT and 32.5% exclusive VBT. Schedule 1: 3 fractions (Fr) after EBRT and 6Fr (4-6 Gy/Fr) in exclusive VBT. Schedule 2: 7Gy × 1Fr + EBRT and 6Gy × 3Fr in exclusive VBT. Differential cost analysis of the two schedules was retrospectively performed. The direct costs in each schedule were (1) Personnel: radiotherapy technicians, nurses, radiation oncologists, medical physicists, administrative personnel, orderlies; time dedicated by each professional during CT planning acquisitions and delineation of vagina/organs at risk, dosimetric study and evaluation, autoradiography, procedure reporting time during/after treatment, removal of bladder/rectal tubes and applicators, material cleaning and transportation for sterilization; (2) Health care material (gels, gauzes, gloves, etc); (3) Equipment (time equipment used). The differential between the two schedules was estimated. Indirect costs and evaluation of quality of life-adjusted costs were not considered.
RESULTS
The overall reduction in the number of Fr per year in Schedule 2 was 93. Cost savings included treatment time per year: 4,185 min (70 h); personnel: 221€ ($246)/p in EBRT + VBT and 331€ ($368)/p in exclusive VBT; and health care material and equipment: 40€ ($44.5)/p in EBRT + VBT and 90€ ($100.2)/p in exclusive VBT. The overall savings per patient was 261€ ($295) in combined treatment and 421€ ($475.7) in exclusive VBT. The total savings per year with Schedule 2 in 40p was 12,503€ ($13,915.8).
CONCLUSIONS
A 41% reduction in the fractions number in VBT for PEC allowed economic savings of 261€ ($290.5)/p in combined treatment and 421€ ($475.7)/p in exclusive VBT. Other benefits include patient comfort and fewer treatment visits.
目的
本研究旨在分析两种阴道近距离放射治疗（VBT）方案对术后子宫内膜癌（PEC）的直接经济影响，这两种方案在阴道控制和毒性结果方面相似。
材料与方法
2006年至2015年，397例PEC患者接受了VBT治疗：平均每年40例，67.5%接受外照射放疗（EBRT）+VBT，32.5%仅接受VBT。方案1：EBRT后3次分割（Fr），仅接受VBT时为6次分割（4 - 6Gy/Fr）。方案2：仅接受VBT时为7Gy×1次分割 + EBRT，以及6Gy×3次分割。对这两种方案进行了回顾性差异成本分析。每个方案的直接成本包括：（1）人员：放疗技师、护士、放射肿瘤学家、医学物理学家、行政人员、勤杂工；每个专业人员在CT规划采集、阴道/危及器官勾画、剂量学研究与评估、放射自显影、治疗期间/后程序报告、膀胱/直肠导管及施源器移除、材料清洁和灭菌运输过程中投入的时间；（2）医疗保健材料（凝胶、纱布、手套等）；（3）设备（设备使用时间）。估算了两种方案之间的差异。未考虑间接成本和生活质量调整成本的评估。
结果
方案2每年分割次数总体减少93次。成本节约包括每年的治疗时间：4185分钟（70小时）；人员成本：EBRT + VBT组为221欧元（246美元）/例，仅接受VBT组为331欧元（368美元）/例；医疗保健材料和设备成本：EBRT + VBT组为40欧元（44.5美元）/例，仅接受VBT组为90欧元（100.2美元）/例。联合治疗时每位患者总体节约261欧元（295美元），仅接受VBT时为421欧元（475.7美元）。方案2每年40例患者的总节约为12503欧元（13915.8美元）。
结论
PEC的VBT分割次数减少41%，联合治疗时可节约成本261欧元（290.5美元）/例，仅接受VBT时为421欧元（475.7美元）/例。其他益处包括患者舒适度提高和就诊次数减少。
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