Health Services Research
PV QA 3 - Poster Viewing Q&A 3
Purpose/Objective(s): Currently, there are no published studies evaluating the comparative cost of image guidance techniques and fractionation schedules for managing prostate cancer. We hypothesized that image guidance with fiducial markers and onboard imaging with daily orthogonal radiographs, rather than daily cone beam CT (CBCT), is significantly less expensive to deliver, even for hypofractionated courses of IGRT.
Materials/Methods: We utilized time-driven activity-based costing (TDABC) to determine the cost of each IGRT technique, based on resources used rather than charges billed to the payer. Process maps were created detailing each activity in our department, from initial referral to post-treatment follow-up visits. Time estimates for each activity were obtained via staff interviews, and the capacity cost rate (CCR) was calculated for all involved personnel, equipment, and clinical space. Total cost was determined from the product of the time required for each process and its CCR. We specifically compared conventionally fractionated IGRT with a dose of 80 Gy, to hypofractionated IGRT with a dose of 60 Gy in 20 fractions, as well as image guidance using fiducial markers versus daily CBCT, for both fractionation schemes.
Results: The total cost of prostate IGRT to a dose of 80 Gy with daily CBCT was $10,594, $5,066 of which were personnel costs. The cost of prostate IGRT to 80 Gy with fiducial markers and daily kv imaging was $8,489, of which $4,077 were personnel costs. Thus, the difference between daily CBCT and fiducial markers with conventional fractionation was determined to be $2,135 per patient. Of this difference, the cost of additional physician time to review images contributes $931, or 44% of the added cost. For hypofractionated IGRT to a dose of 60 Gy in 20 fractions, the total cost was $6,024 with daily CBCT, versus $5,237 for fiducial markers, with an absolute difference of $787 per patient; physician time comprises $750 of this difference. When comparing standard fractionation to hypofractionation, the difference was $4,570 with daily CBCT, and $3,222 with fiducial markers, in favor of hypofractionated IGRT.
Conclusion: Cost of care will likely play a growing role in treatment decisions, and this analysis shows that hypofractionated IGRT saves thousands of dollars per patient. As hypothesized, IGRT using fiducials is less expensive than IGRT using CBCT. However, the cost savings are only marginal for a hypofractionated course, suggesting that daily CBCT may be utilized for short course IGRT without adversely affecting value.
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