Gabriele P, Ozzello F, Negri G L, Rotta P, Pasquino M, Sinistrero G
Unità di Radioterapia, Università di Torino.
Radiol Med. 1998 Jun;95(6):656-62.
An integrated task force of radiotherapists and administrators of the Piedmont region studied the estimated cost of radiotherapy (RT) to compare it with the figures in the 502/92 law modifying the financing of medical structures. This law changed the financing method from productive factors compensation to actually provided performances compensation.
The RT departments of the Turin and Novara university hospitals, those of Ivrea and Asti and that of the Pinna Pintor Clinic (Turin) participated in the study, with 4889 examinations in the period of interest. The study consisted of 6 steps: 1) defining a nomenclator; 2) making a list of standard resources; 3) calculating the actual resource consumption; 4) relating 2) to 3); 5) calculating cost and times; 6) defining quality standards. A technical and/or a central group(s) carried out all the steps. The nomenclator indicates 13 main activities (e.g., irradiation, telecobalt therapy, brachytherapy, hyperthermia), each of them featuring some subactivities (e.g., telecobalt therapy: flash, a fixed beam, two opposing beams). The following productive factor were considered: a) personnel; b) material; c) investments; d) the service cost; e) general costs. The personnel cost (the main cost) was calculated as: A) routine activity; B) activity for other units; C) congress activity; D) research. The times for individual performances were estimated according to professional roles (e.g., medical doctor, physicist, technician, nurse, administrative) for each subactivity.
The estimated RT costs were as follows (please note that all figures are expressed in US $, at a rate of 1$ = ItL 1700). Irradiation: 15 (cost/session +/- 3%); telecobalt therapy: 30-55; Linac (energy < > 10 Mev): 38-60; special techniques: 931-2,314; HDR brachytherapy: 878-1,515; hyperthermia: 285; simulation: 50-92; dosimetry: 52-286; examination, treatment planning, follow-up, etc.: 24-59; immobilization devices, photographs, etc.: 3-66. The quality criteria are related to the personnel; high energy equipment; treatment planning; 3D dosimetry.
Our study led the Italian Ministry of Health to revise the estimated cost of RT examinations in July, 1996. We will further enquire into the new figures.
皮埃蒙特地区的放疗师和管理人员组成的综合特别工作组研究了放射治疗（RT）的估计成本，以便与修改医疗结构融资的502/92号法律中的数据进行比较。该法律将融资方式从生产要素补偿改为实际提供服务的补偿。
都灵和诺瓦拉大学医院的放疗科、伊夫雷亚和阿斯蒂的放疗科以及皮纳·平托诊所（都灵）参与了研究，在感兴趣的时间段内共有4889例检查。该研究包括6个步骤：1）定义一个术语表；2）列出标准资源清单；3）计算实际资源消耗；4）将2）与3）关联；5）计算成本和时间；6）定义质量标准。所有步骤均由一个技术和/或中央小组执行。术语表列出了13项主要活动（例如，照射、远距离钴治疗、近距离治疗、热疗），每项活动都有一些子活动（例如，远距离钴治疗：单次照射、固定束、两个相对束）。考虑了以下生产要素：a）人员；b）材料；c）投资；d）服务成本；e）一般成本。人员成本（主要成本）计算如下：A）日常活动；B）为其他单位开展的活动；C）会议活动；D）研究。根据每个子活动的专业角色（例如，医生、物理学家、技术人员、护士、行政人员）估计各项操作的时间。
放射治疗的估计成本如下（请注意，所有数字均以美元表示，汇率为1美元 = 1700意大利里拉）。照射：15美元（每次治疗成本±3%）；远距离钴治疗：30 - 55美元；直线加速器（能量<>10兆电子伏）：38 - 60美元；特殊技术：931 - 2314美元；高剂量率近距离治疗：878 - 1515美元；热疗：285美元；模拟：50 - 92美元；剂量测定：52 - 286美元；检查、治疗计划、随访等：24 - 59美元；固定装置、照片等：3 - 66美元。质量标准与人员、高能设备、治疗计划、三维剂量测定有关。
我们的研究促使意大利卫生部在1996年7月修订了放射治疗检查的估计成本。我们将进一步研究这些新数据。
