Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA.
Department of Radiation Medicine, Georgetown University School of Medicine, Washington, DC.
Brachytherapy. 2020 May-Jun;19(3):348-354. doi: 10.1016/j.brachy.2020.02.005. Epub 2020 Mar 28.
Intraoperative radiation therapy is an emerging option for adjuvant therapy for early stage breast cancer, although it is not currently considered standard of care in the United States. We applied time-driven activity-based costing to compare two alternative methods of breast intraoperative radiation therapy, including treatment similar to the techniques employed in the TARGIT-A clinical trial and a novel version with CT-guidance and high-dose-rate (HRD) brachytherapy.
Process maps were created to describe the steps required to deliver intraoperative radiation therapy for early stage breast cancer at each institution. The components of intraoperative radiation therapy included personnel, equipment, and consumable supplies. The capacity cost rate was determined for each resource. Based on this, the delivery costs were calculated for each regimen. For comparison across centers, we did not account for indirect facilities costs and interinstitutional differences in personnel salaries.
The CT-guided, HRD form of intraoperative radiation therapy costs more to deliver ($4,126.21) than the conventional method studied in the TARGIT-A trial ($1,070.45). The cost of the brachytherapy balloon applicator ($2,750) was the primary driver of the estimated differences in costs. Consumable supplies were the largest contributor to the brachytherapy-based approach, whereas personnel costs were the largest contributor to costs of the standard form of intraoperative radiation therapy.
When compared with the more established method of intraoperative radiation therapy using a portable superficial photon unit, the delivery of treatment with CT guidance and HDR brachytherapy is associated with substantially higher costs. The excess costs are driven primarily by the cost of the disposable brachytherapy balloon applicator and, to a lesser extent, additional personnel costs. Future work should include evaluation of a less expensive brachytherapy applicator to increase the anticipated value of brachytherapy-based intraoperative radiation therapy.
术中放射治疗是早期乳腺癌辅助治疗的一种新兴选择，尽管它目前不是美国的标准治疗方法。我们应用时间驱动的作业成本法比较了两种不同的乳腺癌术中放射治疗方法，包括类似于 TARGIT-A 临床试验中采用的技术的治疗方法和一种具有 CT 引导和高剂量率（HRD）近距离放射治疗的新型方法。
创建流程图以描述每个机构提供早期乳腺癌术中放射治疗所需的步骤。术中放射治疗的组成部分包括人员、设备和消耗品。确定了每个资源的产能成本率。在此基础上，计算了每种方案的治疗费用。为了进行跨中心比较，我们没有考虑间接设施成本和机构间人员工资的差异。
与在 TARGIT-A 试验中研究的常规方法相比，CT 引导的 HRD 形式的术中放射治疗的治疗费用更高（4126.21 美元）。近距离放射治疗球囊施源器的成本（2750 美元）是造成成本差异的主要原因。消耗品是近距离放射治疗方法的最大贡献者，而人员成本是标准形式术中放射治疗成本的最大贡献者。
与使用便携式浅层光子设备的更成熟的术中放射治疗方法相比，使用 CT 引导和 HDR 近距离放射治疗的治疗费用明显更高。额外成本主要由一次性近距离放射治疗球囊施源器的成本驱动，其次是额外的人员成本。未来的工作应包括评估更经济的近距离放射治疗施源器，以提高基于近距离放射治疗的术中放射治疗的预期价值。
