ESTRO 2021 Abstract Book


ESTRO 2021

registries. The incidence rates of the 10 most common cancer cases, treated with RT in each country were multiplied by the respective RT utilization rate, according to the IAEA model. After adjusting per country, factors assuming 240 working days, 50 patients treated per teletherapy unit/day, 25 EBRT fractions per diagnosis and an equivalent USD 100 cost per fraction, 4 BT fractions for suitable diagnosis were also taken into analysis. Human resource deficits were estimated after the annual cancer incidence, in regard to the IAEA’s recommendation. The 10-year incidence and costs projection were calculated according to the estimated demography dynamics and Time Value of Money (TVM) equation for each single country for the upcoming 10 years. Current and projected cancer incidences, RT, personnel and logistic requirements are reported through absolute numeric differences and mean values. Additionally, potentially saved lives (PSL; assumed 50% of newly included patients after increasing RT capacities) and monetary return are reported. Results Information concerning the 11 most populated Latin-American countries was obtained. As of 2020, a total population of 557,213,447 individuals was registered, projected to increase to 772,038,620 (+214,825,173) by 2030. The current overall cancer incidence is 1,055,892 while the mean incidence per country was 95,990 (SD 135,012.94). The 10-year projection yielded a total 1,460,154 new cases with a mean 132,741 (SD 188,832.23) per country. The overall 2020 EBRT utilization rate was estimated for 657,400 new cases against 908,420 by 2030, while for BT 290,687 and 401,984 new cases were estimated, respectively. The actual EBRT and BT availability of treatment fractions is 11,256,00 and 325,440, respectively. Conversely, the current and 2030’s required number of fractions is 16,435,007 and 22,710,500, and 1,162,747 and 1,607,935, for both EBRT and BT. This resulted in a 11,454,500 (EBRT) and 1,282,495 (BT) fraction availability deficit until 2030. Covering the projected demand, an additional 389,402 PSL in 2030 could be achieved, accounting for a total financial return of USD 1,114,428,294.7. Conclusion Bridging the gap in RT towards 2030 will save lives and reduce the financial toxicity of cancer management in Latin American countries. Governmental and private investment in RT is urgently required in order to shorten access disparities and achieve these goals. 1 Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; 2 Leeds Institute of Health Science and Leeds Cancer Centre, Leeds University and Leeds Teaching Hospital NHS Trust , Leeds , United Kingdom; 3 Finance department, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom; 4 Radiotherapy Physics department. , LCC, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom; 5 Division of Cancer Sciences, , School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; 6 Leeds Institute of Medical Research and Leeds Cancer Centre, Leeds University and Leeds Teaching Hospital NHS Trust , Leeds, United Kingdom; 7 Radiation Oncology Department, Ghent University Hospital, Ghent, Belgium; 8 Edinburgh Cancer Research Centre, University of Edinburgh , Edinburgh , United Kingdom Purpose or Objective The increased use of hypofractionated radiotherapy (RT) for prostate and breast cancer changes the activity within a department. Ultra-hypofractionation has been an international standard of care in palliative RT, particularly for bone metastases, for over 20 years. While expected to be cost-effective due to reduced attendances, many resources requiring capital investment cannot be released when fractions are forgone. We analyse the extent to which treatment costs are fixed (buildings etc), stepped (linear accelerators), variable (materials) or semi-variable (staff) and how total cost, from a healthcare provider perspective, reacts to change in departmental activity. Materials and Methods Using the treatment of bone metastases (with five differing strategies) as an exemplar, we used a time-driven activity-based approach to estimate the cost of RT in a single, large NHS provider (Leeds Teaching Hospitals NHS Trust). Costs are included from a provider perspective for the 2016/17 financial. Hospital level overhead were included at 15.4%. We estimate the treatment cost of five bone metastasis treatment strategies from the healthcare provider perspective and compare to NHS reimbursement tariff. The share of these costs attributable to fixed, semi- variable, stepped and variable costs was assessed. To consider the consequences of hypofractionation, the departmental fraction activity was systematically reduced (by up to 10,000 fractions per year) to assess the impact of this change upon the total cost of delivering remaining treatments with varying levels of disinvestment from staff and equipment. Results The estimated cost of delivering RT for bone metastases ranges from £376 for a single fraction to £3,700 for a fractionated 45Gy in 25# course. These align closely with NHS reimbursement, except for the SABR strategy where tariff during early commissioning exceeds total provider costs by 15.3%. Whilst semi-variable staff costs account for 28.0-39.5% of the total treatment cost, a somewhat larger proportion (38.5-54.8%) is attributable to fixed and stepped costs (Fig.1). The consequences of reducing fraction activity, upon the cost of remaining treatment courses, are illustrated in Fig.2. The greatest impact is seen in fractionated treatments. Disinvestment from semi-variable (staff) costs has a relatively modest impact upon remaining total costs whilst disinvestment from stepped costs (linear accelerators) has a greater impact on total cost although this can only be realised at thresholds aligning to equipment capacity. OC-0058 Impact of increased hypofractionation on treatment cost N. Defourny 1 , K. Spencer 2 , D. Tunstall 3 , V. Cosgrove 4 , K. Kirkby 5 , A. Henry 6 , Y. Lievens 7 , P. Hall 8

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