ESTRO 2024 - Abstract Book

S2787

Interdisciplinary - Health economics & health services research

ESTRO 2024

shortage index (LSI). We gathered comprehensive data on the number of new cancer cases, LINACs per region and state, and cancer cases needing RT treatment. A LSI index was calculated as a relative measure of LINAC demand compared with supply based on number of new cancer cases, number of patients requiring radiotherapy (50% of the global cancer population), and the number of LINACs in the region or state. The LSI, targeting 450 patients (LSI 450) or 600 patients (LSI 600) treated per LINAC, was developed. Based on this index, cancer incidence data, and geographical considerations, we applied a prioritization framework to direct our value-based analysis and country specific recommendations. The LINAC shortage index (LSI) is categorized into: LS grade 0 (no additional demand) to 3 (very high demand). A sensitivity analysis assuming at least 1 LINAC per department was done to estimate LSI.

Results:

In 2020, Colombia recorded an estimated 113,221 new cancer cases. Projections suggest a significant increase in incidence by 69.3%, reaching 191,631 new cases by 2040. Currently, Colombia has 94 LINACs, inclusive of two CyberKnife and two Gamma Knife machines. However, these machines are not evenly distributed: 12 states, housing 3.7 million people (representing 37.5% or 12 out of 32 states), do not have any LINACs. In the states that do have LINACs, the average is 2.97 LINACs per state, with a range from 1 to 14 LINACs. For 2020, an estimated 56,610 cancer patients in Colombia required radiotherapy (RT). This figure is expected to rise to approximately 96,000 patients by 2040. Assessing the infrastructure, Colombia maintains a ratio of 1.8 LINACs per million inhabitants, which falls short of the IAEA guidelines recommending 4 LINACs per million residents. The country faces a stark ratio of 602 cancer patients per LINAC, surpassing the IAEA's advised ratio of one LINAC for every 450 patients. To align with the international standard, Colombia would need a total of 126 LINACs, highlighting a current deficit of 31 units. Based on the GLOBOCAN 2020 cancer incidence data, Colombia's LSI 450 stood at 133, which is 33% below the required RT capacity for all states. However, when considering only the 20 states equipped with LINAC, the average was 163.4, ranging from 60 to 385.The LSI 600 was 100 for all states and the average was 122 for the 20 LINAC equipped states, with a range of 45 to 288. However, when considering all 32 states and adjusting for an scenario in the 12 states without LINACs (assuming at least 1 LINAC for every state), the mean LSI 450 and 600 were projected at 130.67(ranging from 11.56 to 385.18) and 98 (ranging from 8.67 to 288.89), respectively. Nationally, the LSI grade stood at 2, signifying a high demand for additional LINACs. Finally, based on the LSI 450 data, we formulated a national prioritization framework to guide value-based decisions in radiotherapy investment (Table 1).