Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, United Kingdom; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, United Kingdom.
The PRECISE Group, University of Manchester, United Kingdom.
Radiother Oncol. 2022 Jan;166:180-188. doi: 10.1016/j.radonc.2021.11.035. Epub 2021 Dec 7.
BACKGROUND/PURPOSE: The increased use of hypofractionated radiotherapy changes department activity. While expected to be cost-effective, departments' fixed costs may impede savings. Understanding radiotherapy's cost-drivers, to what extent these are fixed and consequences of reducing activity can help to inform reimbursement strategies.
MATERIAL/METHODS: We estimate the cost of radiotherapy provision, using time-driven activity-based costing, for five bone metastases treatment strategies, in a large NHS provider. We compare these estimations to reimbursement tariff and assess their breakdown by cost types: fixed (buildings), semi-fixed (staff, linear accelerators) and variable (materials) costs. Sensitivity analyses assess the cost-drivers and impact of reducing departmental activity on the costs of remaining treatments, with varying disinvestment assumptions.
The estimated radiotherapy cost for bone metastases ranges from 430.95€ (single fraction) to 4240.76€ (45 Gy in 25#). Provider costs align closely with NHS reimbursement, except for the stereotactic ablative body radiotherapy (SABR) strategy (tariff exceeding by 15.3%). Semi-fixed staff costs account for 28.1-39.7% and fixed/semi-fixed equipment/space costs 38.5-54.8% of provider costs. Departmental activity is the biggest cost-driver; reduction in activity increasing cost, predominantly in fractionated treatments. Decommissioning linear accelerators ameliorates this, although can only be realised at equipment capacity thresholds.
Hypofractionation is less burdensome to patients and long-term offers a cost-efficient mechanism to treat an increasing number of patients within existing capacity. As a large majority of treatment costs are fixed/semi-fixed, disinvestment is complex, within the life expectancy of a linac, imbalances between demand and capacity will result in higher treatment costs. With a per-fraction reimbursement, this may disincentivise delivery of hypofractionated treatments.
背景/目的：随着分次剂量放疗的应用增加，改变了科室的工作量。虽然预计这种治疗方式具有成本效益，但科室的固定成本可能会阻碍节约成本。了解放疗的成本驱动因素，以及这些因素在多大程度上是固定的，以及减少活动对剩余治疗成本的影响，可以帮助制定报销策略。
材料/方法：我们使用时间驱动的作业成本法，对英国国家医疗服务体系（NHS）大型供应商的五种骨转移治疗策略的放疗提供成本进行了估算。我们将这些估算与报销费率进行了比较，并按成本类型（固定成本[建筑物]、半固定成本[人员、线性加速器]和可变成本[材料]）对其进行了细分。敏感性分析评估了成本驱动因素以及减少科室活动对剩余治疗成本的影响，并对不同的投资退出假设进行了分析。
骨转移的放疗成本估计范围从 430.95 欧元（单次分割）到 4240.76 欧元（45Gy 分 25 次）。提供者成本与 NHS 报销非常吻合，除了立体定向消融放疗（SABR）策略（费率高出 15.3%）之外。半固定人员成本占提供者成本的 28.1-39.7%，固定/半固定设备/空间成本占提供者成本的 38.5-54.8%。科室活动是最大的成本驱动因素；活动减少会增加成本，主要是在分割治疗中。停用线性加速器可以改善这种情况，但只能在设备容量达到阈值时实现。
与分次剂量放疗相比，大分割放疗对患者的负担更小，从长期来看，是一种在现有容量内治疗越来越多患者的经济有效的机制。由于大多数治疗成本是固定/半固定的，因此投资退出是复杂的，在直线加速器的预期寿命内，需求和容量之间的不平衡将导致治疗成本增加。由于按次计费的报销方式，这可能会抑制大分割放疗的实施。
