放疗成本分析的适应性框架：应用于荷兰肺癌质子与光子治疗的成本。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-03-08 DOI:10.1016/j.radonc.2025.110832

Bradley M. Sugden , Willem J.A. Witlox , Bram L.T. Ramaekers , Djoya Hattu , Boy Vluggen , Judith van Loon , Maria Jacobs , Manuela A. Joore , Dirk K.M. De Ruysscher

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引用次数: 0

摘要

背景/目的：与光子放射治疗（PhT）相比，质子放射治疗（PrT）可能为肺癌提供临床益处，但费用更高。文献报道PrT、PhT的成本及其比较，特别是从社会角度来看，很少。本研究旨在从社会和医疗保健的角度，提供一个可适应的框架来估计PrT/PhT的成本，并通过应用于肺癌。方法：遵循荷兰成本计算指南来估计从第一次转诊到治疗结束的费用。进行了平行基本情况，其中中心特定输入取代了一般输入参数。使用蒙特卡罗模拟（10,000次迭代）以概率方式计算成本，并将其分为三类：医疗保健（细分为人员、非人员）、患者/家属以及其他部门的成本。使用时间驱动的基于作业的成本法估算直接医疗人员成本，允许分离非分数相关成本。进一步的敏感性/情景分析进行了探讨。结果：从社会角度来看，PrT的固定成本（指南[特定中心]分析的平均值）为11,208欧元（12,299欧元），PhT为9,651欧元（10,977欧元）。每个分数的可变成本为PrT的932欧元（798欧元）和PhT的265欧元（265欧元）。PrT与PhT的总成本比在20个分数方案中为2.00[1.74]，在30个分数方案中为2.23[1.91]。PrT与PhT相比，最大的增量成本驱动类别是非（直接）人员医疗保健成本（间接费用、资本支出）。结论：开发了一个适用于概率成本分析的框架。结果突出了PrT和PhT之间的成本差异，并为未来的成本效益分析提供了信息。情景揭示了临床经验的潜力和缩小差异的能力的增强。平行基本案例分析强调了在使用通用和特定中心投入时产生的成本差异，以及中心之间潜在的结果差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Adaptable framework for cost-analyses in radiotherapy: Application to the cost of proton versus photon therapy for lung cancer in The Netherlands

Background/purpose

Proton radiation-therapy (PrT) may provide clinical benefit for lung cancer compared to photon radiation-therapy (PhT), however is more costly. Literature reporting costs for PrT, PhT, and comparisons thereof, particularly from a societal perspective, are scarce. This study aims to provide an adaptable framework to estimate PrT/PhT costs, demonstrated through application to lung cancer, from societal and healthcare perspectives.

Methods

Dutch Costing Guidelines were followed to estimate costs from first referral to end of treatment. A parallel base-case was conducted whereby centre-specific inputs replaced general input parameters. Costs were calculated probabilistically using Monte Carlo simulations (10,000 iterations) and separated into three categories: healthcare (subdivided: personnel, non-personnel), patient/family, and costs in other sectors. Direct healthcare personnel costs were estimated using time-driven activity-based costing, allowing separation of non-fraction-dependant costs. Further sensitivity/scenario analyses were explored.

Results

Fixed costs (guideline[centre-specific] analyses mean) from a societal perspective were €11,208[€12,299] for PrT and €9,651[€10,977] for PhT. Variable costs per fraction were €932[€798] for PrT and €265[€265] for PhT. Total cost ratio for PrT to PhT was 2.00[1.74] for 20 fraction schedules and 2.23[1.91] for 30 fractions. The greatest incremental cost driver category for PrT versus PhT was non–(direct)personnel healthcare costs (overheads, capital outlays).

Conclusion

An adaptable framework for probabilistic cost-analyses was developed. Results highlight cost disparities between PrT and PhT and serves to inform future cost-effectiveness analyses. Scenarios reveal potential for clinical experience and increased capacity to narrow differences. Parallel base-case analyses highlight cost disparities arising when utilising generic vs centre-specific inputs, and potential outcome differences between centres.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.