Coverage with evidence development program on stereotactic body radiotherapy in Belgium (2013-2019): a nationwide registry-based prospective study.

Background: Although stereotactic body radiotherapy (SBRT) was progressively adopted in clinical practice in Belgium, a reimbursement request in 2011 was not granted because of remaining clinical and economic uncertainty. A coverage with evidence development (CED) program on SBRT started in 2013, with the aim to assess clinical and technical patterns-of-care in Belgium and monitor survival per indication, in view of supporting inclusion in the reimbursement system.
Methods: The Belgian National Institute for Health and Disability Insurance (NIHDI) initiated this prospective observational registry. Participating departments, using SBRT in clinical practice, signed the 'NIHDI convention'. Eligible patients had a primary tumour (PT) or oligometastatic disease (OMD). Patient, tumour, and treatment characteristics were collected through an online module of the Belgian Cancer Registry, prerequisite for financing. Five-year overall survival (5YOS) and 30- and 90-days mortality were primary outcomes, derived from vital status information.
Findings: Between 10/2013 and 12/2019, 20 of the 24 accredited radiotherapy departments participated, 6 were academic. Registered cases per department ranged from 21 to 867. Of 5675 registrations analysed, the majority had good performance status and limited number of lesions. Enrolment of PTs remained stable over time, OMDs almost doubled. Peripheral lung lesions dominated in PTs as in OMDs. Other metastases were (para)spinal, 'non-standard' and hepatic. Thirty- and 90-days mortalities remained below 0.5% [95% CI 0.3%-0.8%] respectively 2.1% [95% CI 1.6%-2.7%]. 5YOS varied by indication, primary prostate patients performing best (85%, 95% CI [76%, 96%]), those with liver metastases worst (19%, 95% CI [15%, 24%]). Better OS was observed in academic departments, department size did not significantly impact survival. OMD survival was better in 2018-19.
Interpretation: CED can be used to define patterns-of-care and real-life outcome of innovative radiotherapy. As the observed survival for different indications was in line with outcome in emerging literature, SBRT was included in the Belgian reimbursement system as of January 2020.
Funding: NIHDI financed participating departments per registered case.
Competing Interests: All authors have completed the ICMJE disclosure form and declare: YL is recipient of the HERO-VBHC chair, with payments made to her institution and has unpaid leadership roles in ESTRO (Scientific Committee member and ESTRO-HERO co-chair), the Belgian College of Oncology (Board member) and in the EORTC-ESTRO E2-RADIATE project (PI); DV has research collaboration with RaySearch Laboratories and received speakers fees from BeSTRO and JASTRO and per diem payment as teacher in the ESTRO SBRT course, and reports advisory roles for the Belgian Supreme Health Council and the Medical Jury of the Belgian Federal Agency for Nuclear Control, treasurer of ESTRO and board member of ‘Stand Up Against Cancer’; ML receives a grant of the Foundation Against Cancer for proton radiotherapy in pregnancy (ProPOSE). None of the aforementioned payments or roles are in relation to the submitted work. RW receives fees as president of the College for Physicians of Radiation Oncology Centres, which are paid to her institution; SR is working for the NIHDI, HE was working for the NIHDI during the course of the CED program; SJ and NVD both work for the BCR; but none declare financial or personal interests that could have influenced the submitted work. XG, NJ, LM, VR, KS and CW reported no financial or other relationships that might impact the submitted work.
(© 2024 The Authors.)