ESTRO 37 Abstract book

S28

ESTRO 37

1 Ghent university hospital, Radiation Oncology Department, Ghent, Belgium 2 University of Calgary, Oncology Department, Calgary, Canada 3 IDIBELL, University of Barcelona, Barcelona, Spain 4 Trinity College, Radiation Oncology Department, Dublin, Ireland 5 Catalonian Cancer Strategy, Department of Health, Barcelona, Spain 6 ESTRO A.I.S.B.L., HERO, Brussels, Belgium 7 Cancer Centre Léon Bérard, Clinical Research and Innovation Direction, Lyon, France 8 MAASTRO Clinic, Radiation Onology Department, Maastricht, The Netherlands 9 Aarhus University Hospital, Oncology Department, Aarhus, Denmark Purpose or Objective Costing studies in healthcare are essential to guide national funding decisions. However, particularly in radiotherapy (RT), reliable information on the provider’s cost is scarce. To tackle this knowledge gap, the HERO project has developed a time-driven activity based costing (TD-ABC) model for external beam photon radiotherapy (EBRT) at national level. Material and Methods The model provides insight into the resources utilized and costs incurred in the provision of RT by making a distinction between 3 levels of resource consumption: 1) the EBRT-related cost of task groups (personnel) and equipment used in the delivery of EBRT to specific patients, 2) the process-supporting cost and 3) the cost of additional activities within the radiation oncology (RO) program performed by RT staff (e.g. follow-up consultations). The TD-ABC methodology is applied for the first level while a traditional costing approach is used for levels 2 and 3. The model is demonstrated using a fictitious country (Europalia) but with broadly 'standard” European practices from a national health care provider perspective. The inputs on number and cost of resources available, time devoted to different activities and treatment courses delivered are derived from, in order of preference, the HERO data, published models, literature and experts’ opinions (Table 1).

local control benefits for the Australian cancer population. Material and Methods We have previously developed population-based models of optimal, evidence-based RT utilisation, optimal number of fractions per course, and local control and 5- year overall survival benefits for all cancers [1-4]. For this study, an activity-based costing methodology was used to allocate costs to all RT activities associated with each patient’s treatment course (including external beam and brachytherapy). RT activities, including referrals, bookings, consultations, care coordination, pre- simulation activities (e.g. mask, seed insertion etc), simulation, planning, treatment (including image- guidance), treatment reviews, and follow-up consultations, were extracted from the local radiotherapy information system for the 2015/16 financial year. Expenses, including all direct and indirect labour, goods and services, repairs and maintenance, and administrative were extracted from the local financial system for the same period and allocated to each activity using an agreed formula that incorporated the inputs and complexity for each activity. A patient journey for the financial year was constructed by consolidating all the RT activities and their associated costs, and the average cost per fraction was determined. The cost of RT per 5-year overall survival and local control was then estimated. Results Table 1 shows the results. There was 6.2% of all cancer patients alive at 5 years due to guideline-based use of radiotherapy and 24.8% with local control benefit. The average number of fractions per cancer course if guidelines were followed was 18.6 fractions. The average cost per fraction was AU$316. The average cost was AU$23,700 for each person with local control at 5 years because of radiotherapy and AU$94,800 for each person alive at 5-years as a result of radiotherapy.

Parameters Local control Overall survival

Values

24.8%

6.2%

Average recommended fraction per diagnosis of cancer

18.6

Cost per fraction

AU$316

Fractions per local control

18.6 / 24.8% = 75 18.6 / 6.2% = 300 75 X $316 = AU$23,700 300 X $316 = AU$94,800

Fractions per overall survival

Cost per local control

Cost per overall survival

Conclusion The cost of AU$94,800 per 5-year overall surv ival would translate to AU$18,960 per life year gained. Therefore, the cost of radiotherapy is inexpensive if delivered optimally. Policy implications from this study include knowledge about cost to deliver RT to allow one to quantify the expected benefit at a population level. References: [1] Barton. Radiother Oncol. 2014;112:140-4

[2] Shafiq. UNSW PhD Thesis. 2016 [3] Hanna. UNSW PhD Thesis. 2015 [4] Wong. Radiother Oncol. 2016;119:145-9

OC-0065 A TD-ABC model for estimating national cost and resource utilization in EBRT:an ESTRO-HERO analysis. N. Defourny 1 , P. Dunscombe 2 , J.M. Borras 3 , M. Coffey 4 , J. Corral 5 , C. Gasparotto 6 , L. Perrier 7 , J. Van Loon 8 , C. Grau 9 , Y. Lievens 1