ESTRO 38 Abstract book

S1156 ESTRO 38

Substantial cost variation was observed over 2 years, with costs ranging from $3,298 for TOMO, to $10,565 for SBRT. TOMO was notably cheaper than VMAT $4,648, and SRS $3,665 was cheaper than VMAT, with the cost savings attributable to shorter procedure times and fewer fractions despite of higher initial capital costs. Both equipment costs and quality assurance contributed to the high cost of SBRT, where machine quality assurance (QA) and patient specific delivery quality assurance (DQA) costs range up to 54% when single fraction. 3D was only 20% cheaper than TOMO, largely because of workflow. RT costs are predominantly determined by personnel 38% and equipment cost 39%. Machine usage activities consume greatest proportion with treatment delivery 65%, QA 12% and DQA 8%. The use of TDABC is feasible for cost estimation of RT and is converging with other studies when it comes to fractionation. It allows for analyzing cancer services and provides insights into cost‐reduction tactics in an era focused on emphasizing value. By detailing all steps from diagnosis and treatment, this study demonstrates significant cost variation between competing treatments and highlights the impact of QA and DQA time on the actual cost structure. It impulsed us to evaluate resource or practice changes in the 3 major cost drivers: fractionation, QA and DQA. Our aim is to develop a model that establishes a direct and transparent link between equipment, human resources, fractionation and quality assurance data and indications for RT to be used by LMIC when tackling the change of paradigm of using state of the art RT. Unlike published benchmarks for accelerator throughput to allow estimation of the number of Linacs per million people in each country, we vouch for considering the whole patient workflow. EP-2093 Heart sparing with deep inspiration breath hold (DIBH) in left breast treatment: a prospective study V. Vanoni 1 , S. Mussari 1 , L. Bossi 1 , F. Coelli 1 , M. Maino 1 , A. Martignano 2 1 Ospedale Santa Chiara di Trento, Radiation Oncology, Trento, Italy ; 2 Ospedale Santa Chiara di Trento, Medical Physics, Trento, Italy Purpose or Objective The aim of the study was to prospectively assess the dosimetric benefit achievable with the use of the deep inspiration breath hold technique (DIBH) in left breast radiotherapy. Material and Methods 101 patients with left-sided breast cancer underwent left breast irradiation with DIBH. Following an initial training period including the first 25 patients, the following 76 patients were included in the present study: patients were considered for DIBH if they were younger than 55 years or if the OAR-constraints (lung and heart) were unachievable with free breathing (FB). Both FB and DIBH simulation-CT were available for each patient and formed the basis of their dosimetric analysis. Mean heart dose (MHD), left ventricle V25Gy (V25V), V10Gy and V20Gy for ipsilateral lung (V10L, V20L), ipsilateral lung volume (LV) and minimum distance of the heart from the PTV (HDIST) were recorded and the differences (Δ) between FB and DIBH plans were calculated. Results The mean age of the enrolled patients was 50 years (range 31÷66 y). 43.4% of the patients underwent VMAT radiotherapy and 55.3% 3D conformal radiotherapy; 1 patient was planned with a dMLC technique. In 39.5% of the patients, supraclavicular nodes were included in the treatment volume and 7.9% had supraclavicular and internal mammary lymph nodes involved. 72% of the patients enrolled in the study eventually underwent DIBH Conclusion Conclusions

functional treatments.

EP-2092 Time‐driven activity‐based costing for competing treatments using different technology solutions C.K. Torzsok 1 1 Foundation Arturo Lopez Perez, radiation therapy, santiago de chile, Chile

Purpose or Objective Purpose

Adequate and equitable access to radiotherapy (RT) must be a reasonable health care goal worldwide. However, the provision of RT in low to middle income countries (LMIC) faces challenges such as lack of professionals, reimbursement schemes and public policies. Given that the costs of delivering state of the art RT care remain poorly described, this abstract reports results of time‐ driven activity‐based costing (TDABC) for competing treatments using different technology solutions and opens the way for discussions on how to better account for and utilize resources. Material and Methods Methods TDABC is an advanced cost calculation technique that iteratively allocates resource costs to products based on activity consumption weighed by treatment complexity factors. Process maps were developed for each phase of care from the initial visit to end of treatment through 2 years of clinical practice using Cyberknife Stereotactic body radiation therapy treatments (SBRT), Radiosurgery (SRS), Elekta Volumetric Arc therapy (VMAT), Tomotherapy (TOMO) and conformal RT (3D). The costs of materials, equipment, personnel, and space were calculated per unit of time and relative capacity used.

Results Results