Cost and economic evaluation of radiotherapy : Activity-based costing and modeling techniques [printed text] / Yolande Lievens, Author ; Katrien Kesteloot, Thesis advisor ; Walter Van den Bogaert, Thesis advisor . - Leuven [Belgium] : Katholieke Universiteit Leuven (KUL) : Leuven [Belgium] : ACCO, 2002 . - 178 p. : ill. ; 25 cm. + 1 fiche plastifiée. - ( Faculteit der Geneeskunde = Faculty of Medicine) . Thesis submitted in fulfilment of the requirements for the degree of 'Doctor in Medische Wetenschappen', Leuven, 2002 Languages : English ( eng)
| Descriptors: |
Classification
W 74 Medical economics. Health care costs (General)
Indexation
Academic Dissertations ; Belgium ; Costs and Cost Analysis ; Radiotherapy
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| Abstract: |
The rising technological evolution and demand for health care together with budgetary restrictions have resulted
in an increasing interest in the economic aspects of medical interventions. This has led to the recognition of the
need for accurate cost data of the treatments we deliver, be it for departmental managerial purposes, for
economic evaluations or for reimbursement setting. Further research in this field of medicine is of prime
importance to support long-term health care policy planning. In the present thesis, some economic issues of
radiotherapy departments and their treatments have been analysed.
Part 1: Activity-based costing in radiotherapy
Accurate data on the cost of radiotherapy activities and products are scarce. Activity-Based Costing is a refined
cost-accounting technique that calculates product costs by allocating resource costs on the basis of activity
consumption. Its potential in the field of radiotherapy was demonstrated by the development of an ABC model
for the Leuven radiotherapy department, which was found to be feasible and yield accurate cost estimates.
Despite the high cost of equipment, wage costs were found to be the most important cost component, consuming
up to 60% of the total costs. Hence, daily radiotherapy delivery, a highly labour-intensive activity consuming the
largest proportion of machine (and thus personnel) time, is the most costly of all radiotherapy activities. As a
consequence of this, the number of fractions and the treatment time per fraction are the most important
parameters affecting the ultimate product cost.
These findings should be recognised when evaluating new developments in radiotherapy, such as
hyperfractionation, conformal and intensity modulated radiotherapy, which, besides requiring more complex
treatment preparation, also require more treatment time, and thus translate in higher costs. Whether doing the
investment in this additional equipment is worthwhile, should be the object of economic evaluations.
Part 2: Economic evaluations of radiotherapy
Due to the fast evolution of technology and tightening of the budgets, it is no longer possible to deliver all
technologically feasible treatments to all potential beneficiaries. Choices have become unavoidable. Whereas
new therapeutic strategies were classically evaluated on the basis of feasibility, clinical effectiveness and safety,
more recently, economic considerations have been introduced. Central in economic evaluations is the
relationship between the costs of medical interventions and their outcomes. Accurate data on both, ideally over a
sufficiently long time frame, are therefore mandatory. Since it is frequently impossible to obtain all these data
from randomised clinical trials, decision analytic techniques, especially Markov models, are often used instead.
Based on this methodology, two new radiotherapy treatment strategies have been analysed. The models were
built on literature data on effectiveness and on cost data (predominantly) obtained through the ABC program.
The immediate and delayed costs (from a societal viewpoint) and effects of both treatments, compared to a
standard alternative, were evaluated.
The analysis of CHART in non-small cell lung cancer demonstrated that this treatment has a cost-effectiveness
that compares well with that of other NSCLC therapies reported in literature. The ex ante cost-effectiveness
evaluation of the internal mammary and medial supraclavicular lymph node chain irradiation, a treatment
currently under investigation in a large multicenter EORTC study, found IM-MS irradiation not only to be more
effective, but also less costly from a long-term societal perspective.
Based on the assumptions taken in the models, it can therefore be concluded that these treatments should be
denied to patients neither on clinical nor on economic grounds. Nevertheless, multiple barriers have been
described acting against the implementation of literature evidence in daily practice.
The way in which financial and economic aspects may act against the implementation of evidence-based
literature data has been analysed in the last section of this thesis. Although literature evidence converges towards
the use of single fractions for the irradiation of metastatic bone pain, practice surveys have demonstrated that this
schedule remains infrequently used. It was shown that the incentives imbedded in reimbursement may affect the
treatment choice and that the recent change in Belgian radiotherapy reimbursement supports the use of single
fractions in antalgic radiotherapy. |
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Add the result to your basket Make a suggestion Refine your search Apply to external sourcesAspects Socio-économiques des soins de Santé en Belgique / Bruxelles : Institut Belge de l'Economie de la Santé (I.B.E.S.) (1998)
Economic evaluation in cancer care in European journal of cancer, 36(2000)1 ([01/01/2000])
Health Policy / London : Elsevier
