Königsmaier H, de Pauli-Ferch B, Hackl A, Pendl G
Department of Accounting and Auditing, Karl-Franzens University Graz, Austria.
Acta Neurochir (Wien). 1998;140(11):1101-10; discussion 1110-1. doi: 10.1007/s007010050223.
Radiosurgical treatment can be carried out by means of a Gamma Knife or a Linear Accelerator. The Linear Accelerator may be either a single-purpose appliance, exclusively employed in radiosurgery, or an adapted appliance, which is used primarily for fractioned radiotherapy, and only additionally for radiosurgical purposes. The first alternative will be referred to briefly as a "dedicated Linac", the latter as an "adapted Linac". Cost accounting data for these alternatives will be discussed under three main categories: investment costs, operating costs, and finally staffing costs. Costs are only considered to the extent that this is necessary to facilitate a comprehensive cost comparison. Factors for which the costs remain the same or at least broadly the same will from the outset not be taken into consideration. These include, for instance, the costs of general or special administration, diagnosis, and image processing. The results and conclusions of this study therefore cannot be employed immediately in the evaluation of cost reimbursement schemes of the type carried out by agencies responsible for social insurance. Here, appropriate complete cost analyses especially for this purpose are required. The final comprehensive cost comparison reveals that the adapted Linac is the most favourable alternative with small annual quantities of patients. With larger numbers of patients the Gamma Knife represents the most favourable from a cost accounting angle. The dedicated Linac accordingly does not have a cost advantage for any of the examined numbers of patients. Clearly the lowest treatment costs per patient can be achieved by employing a Gamma Knife and using it to capacity.
放射外科治疗可通过伽玛刀或直线加速器进行。直线加速器可以是专门用于放射外科的单一用途设备，也可以是经过改装的设备，主要用于分次放射治疗，仅额外用于放射外科目的。第一种选择简称为“专用直线加速器”，后者称为“改装直线加速器”。这些选择的成本核算数据将在三个主要类别下进行讨论：投资成本、运营成本，最后是人员成本。仅在有助于进行全面成本比较所需的范围内考虑成本。对于成本保持不变或至少大致相同的因素，从一开始就不予考虑。这些因素包括，例如，一般或特殊管理、诊断和图像处理的成本。因此，本研究的结果和结论不能立即用于评估负责社会保险的机构实施的那种成本报销计划。在此，尤其需要为此目的进行适当的完整成本分析。最终的全面成本比较表明，对于每年患者数量较少的情况，改装直线加速器是最有利的选择。对于患者数量较多的情况，从成本核算角度来看，伽玛刀是最有利的。因此，对于所研究的任何患者数量，专用直线加速器都没有成本优势。显然，通过使用伽玛刀并充分利用其能力，可以实现每位患者最低的治疗成本。
