ESTRO 2024 - Abstract Book

S2794

Interdisciplinary - Health economics & health services research

ESTRO 2024

were analyzed, operational and economic efficacy were measured, and predictive model of clinical workload was constructed.

Material/Methods:

The object of the study were patients of RT offices, patients with NMSC, employees of RT offices. Accumulation, correction, systematization of information was carried out in MS Excel 2010. Statistical analysis was carried out using the Jamovi 1.2.12. All radiotherapy centres (n=142) in the country were contacted by email in 2018 to request their contribution to the study. Centres were asked to complete a detailed online questionnaire, using Google Form, on their clinical practices, workload activity and equipment profile. One response from each centre was requested. An email address was provided within the questionnaire introductory text to allow for any required clarification of survey questions. At the second stage of the study, an assessment of the operational efficiency of XRT offices on two hospitals was carried out for 16 years, the features and dynamics of work, an analysis of the treated diseases (n=16011), an assessment of the bed’s turnover (n=2091), the influence of factors on operational efficiency were carried out. For these the direct observation and time tracking (42 X-ray therapy sessions) were conducted. The mathematical modeling was used to predict the loading of the XRT cabinets. The third stage of the research included patients’ pathways (n=2553) analysis. Imitation modelling in AnyLogic 8.7.3 Personal Learning Edition (© The AnyLogic Company) was used to design management models for XRT care. The equipment wear indicator for 56% of XRT devices was within local standards - 12.5 year. 24.4% of the departments had superficial X-ray systems, 2) had a 100 kV device and 22% had a 150 kV device. 75% of the departments had 200kV or 300 kV XRT systems. XRT integration was only in 5% of departments where those were connected with linear accelerators or other radiological information systems (RIS). 90% of XRTC units use one shift regime of work, while 10% worked two shifts per day. Within 2018 59% had no maintenance downtime while 41% had less than 3 months per year downtime. 59% XRT units were services by non-authorized service providers, 7% hospitals have inhouse engineering department and 34% used official vendors for service and maintenance. The average maintenance costs were 3000 - 5000 Euro per year. 49% of radiotherapy doctors use local clinical guidelines to manage XRT-patients, while 15% are guided with international guidelines (NCCN or other). Most (64%) XRT units have workload of 500 patients per year. 81% of XRT units apply the technology for oncology and benign diseases treatment while 19% use XRT only for oncology indications. The lead time for one XRT fraction is 12,5 min, so 36 patients can be treated within one working shift. The total costs per fraction is 9.56 Euro where 66% is for salary, 16% - cost of XRT equipment (after depreciation), 1% - installation, 4% - maintenance, 13% - other costs. Results:

Conclusion:

There are three main models to incorporate XRT into clinical practice: a) XRT cabinets with energy 150-200kV at the multidisciplinary hospital, when 97% of patients are subject to XRT with benign diseases; b) XRT cabinets with energy 200-300kV at the oncological dispensary - for treatment various oncological pathology; c) XRT of 80-100kV at the specialized oncodermatology centers – to treat only non-melanoma skin cancers (98%). These management models ensure efficient use of resources and are focused on patients’ flow.