INNOVATIVE RADIOTHERAPY TECHNIQUES A MULTICENTRE TIME-DRIVEN ACTIVITY-BASED COSTING STUDY
Frank Hulstaert (KCE) (KCE), Anne-Sophie Mertens (Möbius), (Möbius) Caroline Obyn (KCE), Dries Van Halewyck (Möbius), Brieuc van der Straten (Möbius), Yolande Lievens (UZ Gent)
KCE Report 198 Slides show
Accelerated partial breast irradiation (APBI) •Intraoperative (IORT) •Brachy Brachy 4 4-5 5 days •Low risk patients
Example of IORT: Mobetron (MeV electrons)
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Example: Intrabeam (kV photons)
Lumpectomy Whole Breast Irradiation (WBI) WBI + ext. boost Accelerated partial breast irradiation with IORT IORT boost + WBI
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x
IORT (15 IORT (15 WBI WBI (3 to (3 to Ext. boost Ext boost to 30 min) 7 weeks) (2 weeks) x
x
x
x
x
x
x
x
x
Stereotactic body radiotherapy (SBRT)
•Few fractions •High g dose •Precise •Extra imaging + QA 4
Coverage g with evidence g generation
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Innovation
Staged introduction
• Stereotactic body radiotherapy body radiotherapy (SBRT) • Accelerated partial breast irradiation (APBI) • Intraoperative boost breast
• Indications (WG1) • Costs (WG2) • Registry (WG3) • Indication I di ti + technique t h i • Volume + (Outcome)
Francis Colardyn (Consultant), Irina Cleemput (KCE), Sophie Gerkens (KCE), Raf Mertens (KCE), Bert Winnen (RIZIV – INAMI), Hilde Engels (RIZIV – INAMI), Saskia Van den Bogaert (FOD Volksgezondheid – SPF Santé Publique) An Fremout (FANC – AFCN), Isabelle De Pau (FANC – AFCN); Carolien Claeys (FANC – AFCN), Liesbeth Van Eycken (Stichting Kankerregister – Fondation registre du cancer), Nancy Van Damme (Stichting Kankerregister – Fondation registre du cancer), Karen Vos (Stichting Kankerregister – Fondation registre du cancer) De Belgische radiotherapeuten en hun medewerkers die meewerkten in de werkgroepen en de kostenstudie. C CHU de Liège: è Philippe Coucke, C Eric Lenaerts, Jean Vanderick, Nicolas Jansen, Philippe Martinive UZ Gent: Yolande Lievens, Barbara Vanderstraeten, Marc Van Eijkeren GZA Ziekenhuizen Sint-Augustinus, Antwerpen: Philippe Huget, Katrien Erven, Rita Reymen, Reinhilde Weytjens, Mark Vos UZ Brussel: Mark De Ridder, Thierry Gevaert Institut Jules Bordet, Bruxelles: Paul Vanhoutte, Luigi Moretti, John Vercauteren UZ KULeuven: Karin Haustermans, Jan Verstraete OLV Ziekenhuis, Aalst: Luc Verbeke, Samuel Bral, Heidi Roelstraete, Stijn Van Der Heyden, Pol Decroos Jessa Ziekenhuis, Hasselt: Marc Brosens, Paul Bulens, Katrien Spaas, Goele Kippers Centre Hospitalier Jolimont: Carine Mitine, Christian Nicolas, Jean-François Rosier Hôpital Sainte-Elisabeth, Namur: Vincent Remouchamps, Hervé Marchal, Christian Sprumont, François Sergent Experts van andere radiotherapie centra die deelnamen aan de werkgroepen: URA, Antwerpen: Danielle Van den Weyngaert, Bie De Ost, Dirk Van Gestel AZ St. Jan, Brugge-Oostende: Geertrui De Meestere, Sarah Roels AZ St. Lucas, Gent: Frank Bouttens, Pieternel Thysebaert AZ St. Maarten Duffel: Philippe Spaas, Valerie Vandeputte CHIREC, Bruxelles: Richard Burette CH Peltzer-La Tourelle, Verviers: Olivier De Hertogh CHU Charleroi: Anne-Rose Henry Clinique St. Jean - Bruxelles: Sophie Cvilic Cliniques de l’Europe, Bruxelles: Carl Salambier Heilig Hartziekenhuis, Roeselare: Ivan Staelens Grand Hôpital de Charleroi St. Joseph, Gilly: Françoise Gilsoul AZ Groeninge, Kortrijk: Antoon Lambrecht RHMS – Clinique Louis Caty, Baudour: Joelle Fraikin AZ Turnhout: Jean Meyskens, Michel Martens, Katrien Geboers UCL St. Luc, Bruxelles: Pierre Scalliet, Xavier Geets Sara Appeltants (FOD Economie – SPF Economie),: Kris Engels (RIZIV – INAMI), Chris Hubin (RIZIV – INAMI), Alphonse Thijs (RIZIV – INAMI), Herwin De Kind (Vlaams Agentschap Zorg en Gezondheid), Hilde Smets (Vlaams Agentschap Zorg en Gezondheid), Vincent Ronflé (Varian), Bart van Acker (UMC St Radboud, The Netherlands), Hans Kaanders (UMC St Radboud, The Netherlands) Lieven Annemans (Gezondheidseconomie, UGent en VUB), Peter Dunscombe (Medical Physics and Oncology, University of Calgary, Canada), Lionel Perrier (Health technology assessment assessment, Cancer Centre Léon Bérard, Bérard Lyon, Lyon France)
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Timedriven activityactivity based costing ti First patient ti t contact
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Simulation Delineation DDelineation li ti Si l ti Simulation
Top‐down overhead overhead +/‐ 30%
Bottom‐upp ABC
Planning Pl i Planning
Second simulation for for adaptive RT
Treatment session session delivery
End of treatment
Time-driven activity-based costing INDIRECT
DIRECT Equipment
Personnel
Material
Overhead
Material
Time driven RT patient related activities Intake consultation
Medical review
…
Activity consumption T t Treatment cost t t SBRT – lung – APBI ‐ 5 fractions brachytherapy
RT support act. Equipment Maint. & QA
Other
Out of scope RT patient related
RT support
Non‐RT, care activities
Non‐ care activities
Per fraction …
56.6% Mark-up % on treatment cost
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80% fraction 20% patient
Cost of radiotherapy treatment of early breast cancer 9962
10000 9000
8230
8000
7298 6589 6038
7000 Co ost (€)
6000
5693 4979
5000 4000 3000
5735
3483 3008
4790 3440
4208 3890
6693
6583 6111 5055 4683
4588
3955 2744
3063
No boost Ext. boost
2000
IORT boost
1000
Brachy boost
0
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Accelerated partial breast irradiation (APBI) APBI IORT MeV IORT MeV electrons electrons (Mobetron)
€ 3063 + surgery extension
Extra cost if used as a boost € 2500 to 4000 2500 to 4000 + surgery extension
IORT kV photons p (Intrabeam)
€ 2744 + surgery extension
€ 2000 to 2500 + surgery extension
y py Brachytherapy
€ 6693 + Iridium isotope (4‐5 days)
External beam
Not studied
€ 2000 to 2500 + Iridium isotope (+ general anesthesia) (+ hospitalisation) (+ hospitalisation) € 500 to 1500
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Cost of lung cancer treatments with curative intent Cost of curative lung treatments 16 000
Cost perr treatment (€)
14 000 12 000
Maximum of n centres
10 000 7 556
8 000 5 896 6 000
4 994 4 014 3 972
5 943
7 202 6 952 5 491
4 466
4 000
Minimum of n centres 2 000 Mark-up percentage per treatment
Departmental overhead allocated 80% per fraction and 20% per patient
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Recommendations eco e dat o s Coverage based on real costs Evidence-based selection of indications Clinical studies where needed
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Centralisation Quality system Registration Sti Stimuli li for f execution ti off studies t di
Colophon Author(s): Frank Hulstaert (KCE), Anne-Sophie Mertens (Möbius), Caroline Obyn (KCE), Dries Van Halewyck (Möbius), Brieuc van der Straten (Möbius), Yolande Lievens (UZ Gent) Publication date: 25 March 2013 Domain: Health Technology Assessment (HTA) MeSH: Radiotherapy; py; Cost and Cost Analysis y NLM Classification: QZ 269 Language: English Format: Adobe® PDF™ (A4) Legal depot: D/2013/10.273/10 Copyright: KCE reports are published under a “by/nc/nd” C Creative ti C Commons Licence Li http://kce.fgov.be/content/about-copyrights-for-kce-reports. This document is available on the website of the Belgian Health Care Knowledge Centre.
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