ESTRO 2025 - Abstract Book

S2319

Interdisciplinary – Health economics & health services research

ESTRO 2025

Purpose/Objective: The radiotherapy field is characterized by continuous technological developments. However, given the scarcity of resources, care providers cannot invest in all new technologies. A recent example in improved CBCT imaging technology (e.g., Varian HyperSight CBCT imaging) allows for the direct use of CBCT-scans for treatment planning. A break-even analysis can be used to assess whether the added value of such an improved CBCT imaging system outweighs its additional costs (i.e. hardware and software investments). This study aims to aid future decisions by assessing the break-even point of recouping investments in advanced CBCT imaging, achieved by reductions in the costs of planning CT scans in conventional offline adaptive radiotherapy. Material/Methods: A break-even analysis of the number of offline adaptive treatment fraction for various scenarios was conducted. Advanced CBCT-based treatment planning for offline adaptive radiotherapy was compared to current clinical practice (i.e. conventional CBCT imaging using additional CT for treatment planning). To account for differences in costs between centers and countries, we used a range of incremental investment costs from €0 to €105,000 for ownership and a range from €100 to €500 for the cost per planning CT imaging session. Real-world data from a radiotherapy center was obtained to estimate the yearly fraction output capacity. Results: Figure 1 describes the number of required offline adaptive fractions per year as a function of the incremental total cost of ownership per year of the advanced CBCT imaging system, for different costs of planning CT imaging. Based on information of the radiotherapy center, the yearly incremental cost of the advanced CBCT system could be matched when offline adaptive radiotherapy would be used in about 10% of all yearly delivered treatment fractions. Higher CT imaging costs and lower total costs of ownership for an advanced CBCT imaging system would lead to lower estimates. Figure 1.

Conclusion: This economical assessment provides break-even estimates for advanced CBCT imaging allowing treatment planning in comparison to current clinical practice (i.e. conventional CBCT imaging using an additional CT for treatment planning). In this specific case, we show for which parameter values for incremental costs, CT-scan costs and number of offline adaptive treatment fractions, cost savings offset investment costs. Note that these economic aspects should be weighed together with other arguments including clinical outcomes, logistical implications and organizational aspects to inform investment decisions in this new technology.

Keywords: break-even analysis, CBCT, adaptive radiotherapy