Corral Julieta, Algara Manel, Muñoz-Montplet Carles, Eraso Arantxa, Giralt Jordi, Defourny Noémie, Lievens Yolande, Borras Josep Maria
Catalonian Cancer Plan, Department of Health, Government of Catalonia, Barcelona, Spain.
Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet Barcelona, Barcelona, Spain.
Front Public Health. 2024 Dec 19;12:1474376. doi: 10.3389/fpubh.2024.1474376. eCollection 2024.
The aim was to estimate the cost of the external beam radiotherapy (EBRT) in public health care centers in Catalonia (Spain), according to the ESTRO-HERO costing model for 2018.
Personnel, equipment, and activity data from 2018 from the 11 RT centers were used, incorporating European mean values adapted to the Catalan context. Secondly, EBRT costs were estimated, incorporating 2023 fractionation technique and scheme usage percentages. Finally, complementary estimates were included: complementary planning examinations, stereotactic body radiation therapy (SBRT) fiducial markers, and hospital overhead costs.
In 2018, EBRT cost was estimated at EUR 42.2 M for all patients in the region. Directly related treatment activities represented 69.0% of the total cost, while support and non-directly related EBRT activities accounted for 20.2 and 10.8%, respectively. Mean radical treatment cost varied from €1714 (leukemia) to €4,645 (pancreas), and for palliative intent, from €938 (bone metastases) to €1753 (brain metastases). According to the technique used, costs ranged from €1,475 (3D conformal) to €3,608 (rotational IMRT), and by fractionation scheme, from €1,308 (extreme hypofractionation) to €4,094 (standard fractionation). Accounting for 2023 complexity levels, mean treatment cost rose by 0.9%, but varied widely by tumor site, with a 13% increase for stomach cancer, and decreases of -15.0, -24.4, and - 17.2% in myeloma, pancreas, and lung cancer, respectively. Including complementary examinations and hospital overhead costs, mean cost increased by 15.6%.
This study provides a first approximation to EBRT cost using time-driven activity-based costing (TD-ABC) in Catalonia showing the feasibility of the assessment. For each indication, average treatment cost increases with the associated complexity. Additionally, costs decrease with hypofractionation schemes, largely due to lower equipment weight in treatment cost. Consequently, the adoption of stereotactic techniques is driving cost decreases. Overall, this model represents a robust tool for analyzing different possible scenarios, including changes in fractionation and complexity.
旨在根据2018年的ESTRO-HERO成本核算模型，估算西班牙加泰罗尼亚地区公共医疗中心的外照射放疗（EBRT）成本。
使用了2018年11个放疗中心的人员、设备及活动数据，并纳入了根据加泰罗尼亚实际情况调整后的欧洲平均值。其次，估算EBRT成本，纳入2023年的分割技术及方案使用百分比。最后，纳入补充估算：补充计划检查、立体定向体部放疗（SBRT）基准标记以及医院间接费用。
2018年，该地区所有患者的EBRT成本估计为4220万欧元。直接相关的治疗活动占总成本的69.0%，而支持性及非直接相关的EBRT活动分别占20.2%和10.8%。根治性治疗的平均成本从1714欧元（白血病）到4645欧元（胰腺癌）不等，姑息性治疗则从938欧元（骨转移）到1753欧元（脑转移）不等。根据所使用的技术，成本从1475欧元（三维适形放疗）到3608欧元（旋转调强放疗）不等，按分割方案则从1308欧元（超分割）到4094欧元（标准分割）不等。考虑到2023年的复杂程度，平均治疗成本上升了0.9%，但因肿瘤部位而异，胃癌上升了13%，骨髓瘤、胰腺癌和肺癌则分别下降了15.0%、24.4%和17.2%。纳入补充检查和医院间接费用后，平均成本增加了15.6%。
本研究首次在加泰罗尼亚地区使用时间驱动作业成本法（TD-ABC）对EBRT成本进行了近似估算，显示了评估的可行性。对于每种适应症，平均治疗成本随相关复杂程度增加而上升。此外，超分割方案会使成本降低，这主要是由于治疗成本中设备权重较低。因此，立体定向技术的采用推动了成本下降。总体而言，该模型是分析不同可能情况（包括分割和复杂程度变化）的有力工具。
