Objectives: As health care budgets continue to face close
scrutiny, any new acquisition must be evaluated for both costs and outcomes.
This study was undertaken to demonstrate the application of an economic
framework for the evaluation of a multileaf collimator as an example of a new
technology that can have both quantifiable and nonquantifiable benefits for
patients, staff, and cancer care institutions.
Methods: Using financial data from the Northeastern Ontario
Regional Cancer Centre (NEORCC) and a recognized staffing model, a commercial
spreadsheet, developed to economically characterize the principal radiotherapy
processes has been used to determine the net incremental annual cost of a
multileaf collimator (MLC).
Results: The incremental annual cost of purchasing an MLC is
estimated at approximately $85,000 (1997 CDN $). Without increasing patient
throughput, this increases the average cost of a course of radiotherapy by
approximately CDN $200. Savings can be accrued by decreasing mold room
activity, increasing the hourly patient capacity on each treatment machine,
and decreasing sick time due to strain injuries.
Conclusions: Although the clinical outcome of techniques
facilitated by MLCs, such as intensity-modulated radiation therapy, are
unknown at this time, an economic context within which to objectively evaluate
this technology is presented. The framework presented suggests a method of
quantifying outcome-justified expenditures, such as improved patient outcome
and greater treatment flexibility, which, when offset against the incremental
annual equipment cost, may be used to help justify the acquisition of
multileaf technology.