Robards Shannon, Brown Amy, Pain Tilley, Patel Deepti, Tan Alex, Carter Hannah
Townsville Hospital and Health Service, Townsville, Queensland, Australia.
James Cook University, Townsville, Queensland, Australia.
Tech Innov Patient Support Radiat Oncol. 2022 Dec 2;24:131-136. doi: 10.1016/j.tipsro.2022.11.002. eCollection 2022 Dec.
Usual practice for the insertion of prostate fiducial markers involves at least one week delay between insertion and simulation. An evidence-based practice change was implemented whereby fiducial marker insertion occurred on the same day as radiotherapy simulation. The aim of this study was to quantify the health service costs and clinical outcomes associated with this practice change.
A cost-minimisation analysis was undertaken from the perspective of the local health service. A retrospective chart audit was conducted to collect data on 149 patients in the pre-implementation cohort and 138 patients in the post-implementation cohort. Associated costs with insertion and simulation were calculated and compared across the two cohorts; this included subsided travel costs for rural and remote patients. Fiducial marker positions on planning CT and first treatment CBCT were measured for all patients as the surrogate clinical outcome measure for oedema.
The health service saved an average of AU$ 361 (CI $311 - $412) per patient after the practice change. There was no significant difference in fiducial marker position pre- and post- implementation (p < 0.05).
The practice change to perform insertion and radiotherapy simulation on the same day resulted in substantial savings to the health system, without compromising clinical outcomes. The decrease in number of required patient attendances is of real consequence to rural and remote populations. The practice change increases both the value and accessibility of best-practice health care to those most at risk of missing out.
插入前列腺基准标记物的常规做法是在插入与模拟之间至少延迟一周。实施了一项基于证据的实践变革，即基准标记物插入与放射治疗模拟在同一天进行。本研究的目的是量化与这一实践变革相关的卫生服务成本和临床结果。
从当地卫生服务机构的角度进行成本最小化分析。进行了一项回顾性病历审核，以收集实施前队列中149例患者和实施后队列中138例患者的数据。计算并比较了两个队列中与插入和模拟相关的成本；这包括农村和偏远地区患者的交通补贴费用。对所有患者在计划CT和首次治疗CBCT上的基准标记物位置进行测量，作为水肿的替代临床结果指标。
实践变革后，卫生服务机构平均每位患者节省了361澳元（置信区间311 - 412澳元）。实施前后基准标记物位置无显著差异（p < 0.05）。
在同一天进行插入和放射治疗模拟的实践变革为卫生系统带来了可观的节省，同时不影响临床结果。所需患者就诊次数的减少对农村和偏远地区人口具有实际意义。这一实践变革提高了最易错过最佳医疗服务人群获得最佳实践医疗服务的价值和可及性。
