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The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases

Published online by Cambridge University Press:  23 September 2014

Waseem Sharieff ,
Anthony Whitton ,
Tom Chow ,
Doug Wyman ,
James Wright  and
Jeffrey N. Greenspoon
Waseem Sharieff*
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario Department of Radiation Oncology, Cape Breton Regional Cancer Centre, Sydney Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia
Anthony Whitton
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
Tom Chow
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
Doug Wyman
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
James Wright
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
Jeffrey N. Greenspoon
Affiliation:
Department of Radiation Oncology, McMaster University, Hamilton Ontario Juravinski Cancer Centre, Hamilton Health Sciences; Department of Oncology, McMaster University, Hamilton Ontario
*
Department of Radiation Oncology, Cape Breton Regional Cancer Centre, Sydney, Nova Scotia, B1p 1p3, Canada. Email: doc.sharieff@utoronto.ca
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Abstract

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Background:

Radiosurgery can be delivered through a variety of modalities including robotic and fixed gantry linacbased systems. They appear equally effective and safe. Thus, community need and costs remain the main determinants for choosing a given modality. We performed an economic evaluation to identify settings in which one modality could be preferred over the other.

Methods:

Using local estimates of resource volumes and unit prices, we computed the incremental cost/patient of robotic radiosurgery compared to fixed-gantry radiosurgery from a payer's perspective. By varying parameters of resource volumes, we performed a probabilistic analysis stratified by number of brain lesions. in addition, we performed sensitivity analyses to examine the effect of patient volume on cost/patient.

Results:

The cost of robotic radiosurgery was $4,783/patient, and cost of fixed-gantry radiosurgery was $5,166/patient. The mean incremental cost was $-383 (95% interval: $-670, $110) for all lesions, $78 ($23, $123) for solitary lesions, and $-610 ($-679, $-534) for multiple lesions. The cost/patient of robotic radiosurgery varied from $5,656 (low volume setting) to $4,492 (high volume setting).

Conclusion:

in settings of moderate to high volume (6-10 hours of daily operation), and in multiple lesions, robotic radiosurgery is more cost effective than fixed-gantry radiosurgery.

Résumé

RÉSUMÉContexte:

La radiochirurgie peut être administrée au moyen de différentes modalités dont les systèmes robotisés et de type LINAC à portique fixe. Ces modalités de traitement semblent être également efficaces et sûres. Le choix de l'une ou l'autre semble déterminé par les besoins de la communauté et les coûts. Nous avons effectué une évaluation économique pour identifier le contexte dans lequel l'une pourrait être préférée à l'autre.

Méthode:

Nous avons calculé ce que coûterait par patient la radiochirurgie robotisée comparée à la radiochirurgie à portique fixe, du point de vue du payeur, au moyen des estimés locaux du volume des ressources et des prix unitaires. En variant les paramètres du volume des ressources, nous avons effectué une analyse probabiliste stratifiée selon le nombre de lésions cérébrales à traiter. De plus, nous avons effectué des analyses de sensibilité pour examiner l'effet du volume de patients sur le coût par patient.

Résultats:

Le coût de la radiochirurgie robotisée était de 4 783$ par patient et le coût de la radiochirurgie à portique fixe était de 5 166$ par patient. Le coût additionnel moyen était de -383$ (intervalle de confiance à 95% : -670$ à 110$) pour toutes les lésions, 78$ (23$ à 123$) pour les lésions uniques et -610$ (-679$ à -534$) pour les lésions multiples. Le coût par patient de la radiochirurgie robotisée variait de 5 656$ (si le volume était faible) à 4 492$ (si le volume était élevé).

Conclusion:

Si le volume est de modéré à élevé et en opération de 6 à 10 heures par jour, la radiochirurgie robotisée est plus avantageuse au point de vue économique que la radiochirurgie à portique fixe pour traiter les lésions multiples.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 6 , November 2013 , pp. 795 - 799
Copyright
Copyright © The Canadian Journal of Neurological 2013

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