Estimating the Costs of Intensity-Modulated and 3-Dimensional Conformal Radiotherapy in Ontario

Yong, Jean Hai Ein; McGowan, Tom; Redmond-Misner, Ruby; Beca, Jaclyn; Warde, Padraig; Gutierrez, Eric; Hoch, Jeffrey S.

doi:10.3747/co.23.2998

Cited by 25 publications

(20 citation statements)

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“…The wide range of cost differential was affected by the time horizon of the cost analyses (eg, incorporating costs in the 12 mo since diagnosis [39] vs the lifetime of the patient after treatment [40]), health system of the country in which the study took place, whether or not the start-up phase of IMRT was incorporated, and the specific costs being measured (eg, Medicare reimbursements only [41] vs reimbursement costs along with the costs of equipment, supplies, personnel, and overhead [40]). The study with the lowest cost difference ($381) specifically assessed a mature IMRT program [42]. When it examined a scenario in which IMRT was in a start-up phase, the incremental cost of IMRT increased by a factor of 11 to $4268 [42].…”

Section: Evidence Synthesismentioning

confidence: 99%

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Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

et al. 2017

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Context Some of the high costs of robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and proton beam therapy may be offset by better outcomes or less resource use during the treatment episode. Objective To systematically review the literature to identify the key economic trade-offs implicit in a particular treatment choice for prostate cancer. Evidence acquisition We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and protocol. We searched Medline, Embase, and Web of Science for articles published between January 2001 and July 2016, which compared the treatment costs of RARP, IMRT, or proton beam therapy to the standard treatment. We identified 37, nine, and three studies, respectively. Evidence synthesis RARP is costlier than radical retropubic prostatectomy for hospitals and payers. However, RARP has the potential for a moderate cost advantage for payers and society over a longer time horizon when optimal cancer and quality-of-life outcomes are achieved. IMRT is more expensive from a payer’s perspective compared with three-dimensional conformal radiotherapy, but also more cost effective when defined by an incremental cost effectiveness ratio <$50 000 per quality-adjusted life year. Proton beam therapy is costlier than IMRT and its cost effectiveness remains unclear given the limited comparative data on outcomes. Using the Grades of Recommendation, Assessment, Development and Evaluation approach, the quality of evidence was low for RARP and IMRT, and very low for proton beam therapy. Conclusions Treatment with new versus traditional technologies is costlier. However, given the low quality of evidence and the inconsistencies across studies, the precise difference in costs remains unclear. Attempts to estimate whether this increased cost is worth the expense are hampered by the uncertainty surrounding improvements in outcomes, such as cancer control and side effects of treatment. If the new technologies can consistently achieve better outcomes, then they may be cost effective.

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Section: Evidence Synthesismentioning

confidence: 99%

“…The study with the lowest cost difference ($381) specifically assessed a mature IMRT program [42]. When it examined a scenario in which IMRT was in a start-up phase, the incremental cost of IMRT increased by a factor of 11 to $4268 [42]. Two studies found that IMRT costs less than 3D-CRT.…”

Section: Evidence Synthesismentioning

confidence: 99%

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

et al. 2017

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“…The dose deliver for patient in 3DCRT technique is easier than IMRT. It is also lower in cost and less time-consuming compared with IMRT [17] [18].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison between Three Dimensional Conformal Radiation Therapy (3DCRT) & Intensity Modulated Radiation Therapy (IMRT) in Mid-Lower Oesophageal Carcinoma

Taher¹,

Elawady²,

Amin³

2019

IJMPCERO

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Purpose: To investigate if intensity modulated radiation therapy (IMRT) offers a better planning target volume (PTV) coverage and/or lower dose to normal thoracic structures in comparison to three dimensional conformal radiation therapy (3DCRT) in the treatment of mid and lower oesophageal carcinoma patients. Materials and Methods: A prospective study in the period from 2014 till 2015 was held in the radiation therapy department of the National Cancer Institute, Cairo University, in which 20 locally advanced or inoperable mid and lower oesophageal cancer patients were treated by chemo-radiation using 3DCRT technique. IMRT plans were generated for those 20 patients. The 3DCRT and IMRT plans were compared as regards PTV coverage and doses to critical organs at risk. Results: All plans had produced satisfactory PTV coverage with no significant differences noted. The lung V20 for both lungs in 3DCRT was 16.94% ± 4.2% which was increased to 21.42% ± 3.6% in IMRT (p = 0.017). The mean dose to the heart and V30 were higher in IMRT plans while the mean dose to the spinal cord was higher with 3DCRT plans, yet that didn't reach a statistically significant level (p = 0.156). The dose delivered to the liver didn't pose any difference between both techniques. Conclusion: 3DCRT remains to be a feasible cost effective treatment delivery option for mid and lower oesophageal cancer cases with a lower optimization and delivery time than that for IMRT. Moreover, that calls for further dosimetric studies and clinical trials to assess IMRT technique. In our study, IMRT using nine fields didn't prove to be superior to 3DCRT.

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“…Of course, the cost of using new technologies needs to considered as if they only reduce toxicity profile due to treatment. In USA, systematic analysis of Medicare reimbursement data during 2012-2015, for prostate, anal, gynecological and headneck cancers, declared that IMRT has been more costly than 3DCRT approximately 12.834$ per patients and this cost can go up to 19.113$ and breast IMRT has been named as the least expensive IMRT depending on the less complex structure compared to a head and neck workload [43].…”

Section: Imrtmentioning

confidence: 99%

Modern Radiotherapy Era in Breast Cancer

Bölükbaşı¹,

Selek²

2017

Breast Cancer - From Biology to Medicine

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Radiation therapy (RT) is one of the major treatment modalities that are used in breast cancer treatment, and depending on the chest-wall anatomy, RT fields have to be customized. Techniques used in planning have been evolving since last two decades from two dimensional (2D) to three-dimensional (3D), while intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and even proton therapy have been an option in daily approach. In addition, technological hardware and software advances in delivery and planning systems, total treatment duration of breast RT have been shortened in last decades along with recent hypofractionated radiotherapy schemes or emerging partial-breast irradiation protocols. The other attractive approach-accelerated partial breast irradiation (APBI) could be a reasonable option for highly selected subpopulation of early-stage breast cancer patients out of a clinical trial. Long-term follow-up results have emerged heart and coronary sparing with maximum safety and efficacy. The most important advance could be named as cardiac sparing-deep breathhold approach-in all the modern technique improvement. Although most advanced techniques in management of breast cancer have not been verified to increase survival, we suggest recommending resource stratified advanced in order to provide best technical and clinical care in this long-term survivor candidates.

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Estimating the Costs of Intensity-Modulated and 3-Dimensional Conformal Radiotherapy in Ontario

Abstract: Background Radiotherapy is a common treatment for many cancers, but up-to-date estimates of the costs of

Cited by 25 publications

References 25 publications

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

Dosimetric Comparison between Three Dimensional Conformal Radiation Therapy (3DCRT) & Intensity Modulated Radiation Therapy (IMRT) in Mid-Lower Oesophageal Carcinoma

Modern Radiotherapy Era in Breast Cancer

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Estimating the Costs of Intensity-Modulated and 3-Dimensional Conformal Radiotherapy in Ontario

Abstract: Background Radiotherapy is a common treatment for many cancers, but up-to-date estimates of the costs of

Cited by 25 publications

References 25 publications

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

Dosimetric Comparison between Three Dimensional Conformal Radiation Therapy (3DCRT) &amp; Intensity Modulated Radiation Therapy (IMRT) in Mid-Lower Oesophageal Carcinoma

Modern Radiotherapy Era in Breast Cancer

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Product

Resources

About

Dosimetric Comparison between Three Dimensional Conformal Radiation Therapy (3DCRT) & Intensity Modulated Radiation Therapy (IMRT) in Mid-Lower Oesophageal Carcinoma