Innovative radiotherapy techniques : a multicentre time-driven activity-based costing study

75 p. Ill., INTRODUCTION 8 -- 1.1 OBJECTIVES 8 -- 1.2 THE STUDY TEAM . 8 -- 1.3 RADIOTHERAPY A ND INNOVATION 8 -- 1.4 INNOVATIVE RADIOTHERAPY TECHNIQUES AND THEIR INDICATIONS 9 -- 1.4.1 Novel radiotherapy techniques for treating early breast cancer. 9 -- 1.4.2 Stereotactic body radiation therapy (SBRT). 11 -- 1.4.3 Research funding, registration of activities and clinical outcome. 12 -- 2 METHODOLOGY 14 -- 2.1 WHY AN ABC ANALYSIS? 14 -- 2.2 SELECTION AND PARTICIPATION OF RADIOTHERAPY CENTRES 14 -- 2.3 DEFINITION OF RADIOTHERAPY TREATMENTS 15 -- 2.4 TIME-DRIVEN ABC OF RADIOTHERAPY 15 -- 2.5 ACTIVITIES 15 -- 2.6 COSTS AND RESOURCE USE 16 -- 2.6.1 Personnel cost 19 -- 2.6.2 Equipment costs 19 -- 2.6.3 Indirect material costs 19 -- 2.6.4 Pharmaceuticals, radio-isotopes and gold markers 19 -- 2.6.5 Overhead 20 -- 2.6.6 Direct costs 20 -- 2.7 COST ALLOCATION 20 -- 2.7.1 Time based allocation of personnel and equipment costs to patient related activities 20 -- 2.7.2 Allocating activities, materials and overhead to treatments 21 -- 2.8 TOTAL COST PERTREATMENT .22 -- 2.9 DATA COLLECTION TEMPLATES 22 -- 3 RESULTS 23 -- 3.1 CENTRE’S PROFILE 23 -- AVERAGE COST OVER ALL TREATMENTS 25 -- 3.3 SBRT, FOCUS ON THE LUNG 27 -- 3.4 SBRT OF SPINAL, LIVER, PANCREAS, BONE AND OLIGOMETASTASES 30 -- 3.5 BREAST CANCER 31 -- 3.6 PROSTATE CANCER 36 -- 3.7 HEAD AND NECK CANCER 36 -- 3.8 RECTUM CANCER 37 -- 3.9 PALLIATIVE RADIOTHERAPY 38 -- 3.10 COST DETERMINANTS AND EFFICIENCY 39 -- 4 DISCUSSION OF THE RESULTS 42 -- 4.1 THE 10 CENTRES AND THE OVERALL RESULTS 42 -- 4.1.1 General findings . 43 -- 4.1.2 Cost determinants and efficiency 45 -- 4.2 COST OF SBRT COMPARED WITH OTHER MODALITIES . 46 -- 4.2.1 Focus on the lung 46 -- 4.2.2 SBRT of spinal, liver, pancreas, bone and oligometastases 47 -- 4.3 BREAST CANCER, FOCUS ON APBI AND IORT BOOST 48 -- 4.4 COST OF OTHER COMMON TREATMENTS 50 -- 4.5 COSTS, FINANCING AND BUDGET CONSIDERATIONS 50 -- 4.6 INTRODUCING INNOVATIONS IN HEALTH CARE 51