ESTRO 2020 Abstract book

S37 ESTRO 2020

Conclusion In Europe, acceptance of hypofractionated radiotherapy is high in node-negative breast-conserving cases and moderate in low-intermediate risk prostate cancer. Though hypofractionation is the standard for bone metastases, sıngle fraction uptake remains low. Barriers to optimal utilization of hypofractionation need addressing through continuing education and guideline promotion to improve translation of evidence into practice OC-0077 Factors Associated with the Global Availability of Radiotherapy Services: an IAEA analysis J.A. Polo Rubio 1 , E. Zubizarreta 1 , Y. Lievens 2 , M. Barton 3 , D. Rodin 4 , V.D. Jake 5 , S. Grover 6 , M. Abdel-Wahab 1 1 International Atomic Energy Agency, Division of Human Health, Vienna, Austria ; 2 University of Gent, Radiation Oncology, Gent, Belgium ; 3 University of South Wales, Radiation Oncology, Sidney, Australia ; 4 Princess Margaret Cancer Centre. University of Toronto, Radiation Oncology, Toronto, Canada ; 5 The University of Western Ontario, Oncology, London, Canada ; 6 Hospital of the University of Pennsylvania, Radiation Oncology, Philadelphia, USA Purpose or Objective To assess factors associated with the global availability of radiotherapy services. The intent of understanding these factors is to provide insight into the various macro- determinants associated with successful and sustainable radiotherapy over time and to provide guidance on the sustainability of current and future investments in radiation therapy. Material and Methods Using open source data from World Bank, GLOBOCAN and the Directory of Radiotherapy Centers (DIRAC) from IAEA, we created a database of 190 countries with macro- economic (including GDP [Gross Domestic Product] and Health Expenditure) and other socio-economic indicators (including Human Development Index [HDI] and geographic population distribution), cancer incidence, mortality and the availability of radiotherapy equipment. A Time-Driven Activity Based Costing model was used to calculate the estimated costs of radiotherapy. Predictive Ordinary- Least-Squares (OLS) models were calculated to understand the factors affecting the availability of radiotherapy at country level (measured by the number of megavoltage [MV] units per million population and per 1000 cancer cases). Cut-off values for significant independent variables were obtained by Receiver Operating Characteristic (ROC) curve analysis. Results During the last decade the worldwide number of MV units per million population increased by 49.13%, but the variation in the number of MV units per 1000 cancer cases decreased by 11.9% (table 1). Estimated capital costs per capita and operational costs per year per capita (in current US$) of the installed capacity in 2018 were 4.95 US$ and 1.40 US$. Then, we calculated additional costs for up-scale to full coverage: the additional capital costs per capita were 1.92 US$; and the final operational costs per year per capita were 1.53 US$. OLS models identified a strong association between the provision of radiotherapy services at a country level and (1) some economic indicators (GDP and health expenditure), (2) the population distribution (proportion of urban vs. rural population) and (3) the ratio of the estimated operational costs of radiotherapy to the total expenditure in health (table 2).

Conclusion Our findings support the well-known strong association between national radiotherapy capacity and macroeconomic indicators of national wealth and development, but also gives insight on other factors that have been hidden in previous analysis as the geographic distribution of the population (urban population) or not previously reported like the ratio of estimated operational costs in radiotherapy (as a proxy for expenditure in radiotherapy) to total expenditure in health. The fit of our models explains between 60 and 66% of the variance in the dependant variables, suggesting than more explanatory value can be still gained by including other variables. Our group continues to work on the refinement of these findings to provide guidance for investment in radiotherapy. OC-0078 A Cost-effectiveness of Different Approaches to the Treatment of Localized Prostate Cancer A. Harat 1 , M. Harat 2 , M. Martinson 3 1 Collegium Medicum UMK, Public Health, Bydgoszcz, Poland ; 2 Franciszek Lukaszczyk Memorial Oncology Center, Radiotherapy, Bydgoszcz, Poland ; 3 Technomics Research, n/a, Minneapolis, USA Purpose or Objective The aim of this study was to compare the cost- effectiveness and quality-adjusted life years (QALYs) of active monitoring (AM), radical prostatectomy (PR), and external-beam radiotherapy with neoadjuvant hormone therapy (RT) for localized prostate cancer. Material and Methods Microsimulations of radical prostatectomy, 3D-conformal radiotherapy, or active monitoring were performed using Medicare reimbursement schedules and clinical trial results for a target population of men aged 50-69 years with newly diagnosed localized prostate cancer (T1-T2, NX, M0) over a time horizon of 10 years. Quality-adjusted life years (QALYs) and costs were assessed and sensitivity analyses performed. Results