A cost analysis of complex radiotherapy for patients with head and neck cancer

Publication date: Available online 6 February 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Lionel Perrier, Magali Morelle, Pascal Pommier, Pierre Boisselier, Bernard Coche-Dequeant, Olivier Gallocher, Marc Alfonsi, Etienne Bardet, Michel Rives, Valentin Calugaru, Enrique Chajon, Georges Noel, Hinda Mecellem, David Pérol, Sophie Dussart, Prof Philippe Giraud
PurposeThis cost analysis aimed to prospectively assess the difference in costs between TomoTherapy® and Volumetric-modulated Arc Therapy (VMAT) in patients with head and neck cancer.Materials and methodsEconomic data were gathered from a multicenter study. However, randomization was not possible due to the availability of equipment. Costs were calculated using the micro-costing technique from the hospital's perspective (in Euros, 2013) and the time horizon was radiation therapy. Only resources that entered the hospital production process and which were likely to vary between the strategies being compared were considered. Acute adverse events observed within the time horizon were also assessed.ResultsThe cost analysis was based on a total of 173 patient treatments between 2010 and 2012 in 14 French cancer centers: 73 patients were treated with TomoTherapy®, 92 with VMAT RapidArc® and 8 with VMAT SmartArc®. Estimated costs of SmartArc® were removed from the comparison, due to the small sample size. The mean cost per patient of the treatment planning phase was €314 (SD: 214) for TomoTherapy® and €511 (SD: 590) for RapidArc®. The mean costs per patient of irradiation reached €3,144 (SD: €565) for TomoTherapy® and €1,350 (SD: €299) for RapidArc®. The most sensitive parameter of irradiation was the annual operating time of accelerators. 95% confidence intervals for the mean costs of irradiation were [€3,016-€3,272] for TomoTherapy® and [€1,281-€1,408] for RapidArc®. The number of acute adverse events during radiotherapy was not significantly different between strategies.ConclusionTomoTherapy® appeared more expensive than RapidArc® mainly due to the higher price of the accelerator, the higher costs of maintenance, and the longer duration of the treatment sessions. Since the strategies were not significantly different in clinical effect, RapidArc® appeared to be the strategy to be recommended in this stage of knowledge.

Teaser

Economic evaluations of Intensity-modulated radiotherapy (IMRT) have been conducted in head and neck cancer, but none has compared Helical Tomotherapy with Volumetric-modulated Arc Therapy (VMAT). In this study, we have compared the costs of TomoTherapy® with VMAT RapidArc®. The cost of TomoTherapy® appears to be higher. Since the numbers of acute adverse events during radiotherapy were not significantly different, RapidArc® appeared to be the preferred strategy in the short-term.


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