Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_35_2943 - Time-driven activity based costing of CT-guided vs. MR-guided SBRT in patients with unresectable hepatocellular carcinoma

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Time-driven activity based costing of CT-guided vs. MR-guided SBRT in patients with unresectable hepatocellular carcinoma
N. R. Parikh1, P. Lee1, S. Raman2, M. Cao1, M. Tyran1, J. M. Lamb1, N. Agazaryan1, M. L. Steinberg3, and A. Raldow1; 1Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 2Department of Diagnostic and Interventional Radiology, University of California, Los Angeles, Los Angeles, CA, 3University of California, Los Angeles, Los Angeles, CA

Purpose/Objective(s): Magnetic resonance (MR) guided radiation therapy has recently become commercially available, offering the opportunity to more accurately image and target moving tumors as compared to computed tomography (CT) guided systems. However, the costs of delivering care with these two modalities remain poorly described, and determining “value” in health care (defined as outcomes per unit cost) depends on accurately measuring cost. Using localized unresectable hepatocellular carcinoma as an example, we used time-driven activity-based costing (TDABC) to determine the cost of treating these tumors on linear accelerators (LINAC) with CT- versus MR-guided stereotactic body radiation therapy (SBRT).

Materials/Methods: Process maps consisting of discrete steps (each with personnel, time involved, space utilized, and materials used) were created for each phase of the SBRT care cycle: consultation, simulation, planning, treatment, on-treatment visit (OTV), and follow-up visit. Aside from OTV and follow-up visits, separate process maps were created for CT- vs. MR-guided SBRT. Mapping was informed by conducting interviews with attending physicians, physicists, dosimetrists, nurses, therapists, and front-office staff. Additional sources of data to determine costs included salary/benefit data of personnel, average list price and maintenance costs for equipment, and floor plan. Space/equipment were assumed to be available for clinical use 5 days per week and 11.5 hours per day. The SBRT process of care included 5 SBRT treatments (10 Gy each), 1 OTV visit, and 1 follow-up visit. To reflect common practice, CT-guided SBRT utilized volumetric modulated arc therapy and a free-breathing technique with abdominal compression, while MR-guided SBRT utilized static gantry intensity-modulated radiation and real-time gating of tumor with deep inspiration breath-hold.

Results: Our analysis estimated total cost of care to be $6,140 for CT-guided SBRT and $7,247 for MRI-guided SBRT. Costs for CT- vs. MR-guided SBRT were comprised of personnel ($3,807 vs. $3,651 respectively), space/equipment ($2,159 vs. $3,458 respectively), and materials ($174 vs. $62 respectively). Increased space/equipment costs in MR-guided SBRT vs. CT-guided SBRT were driven by increased time spent in the treatment vault during simulation (41 minutes vs. 0 minutes) and during each of the 5 treatment sessions (54 minutes vs. 38 minutes). These increased costs from MR-guided SBRT were somewhat tempered by the cost of fiducial placement ($1,172) which was required only for CT-guided SBRT.

Conclusion: TDABC can be used to measure costs across an entire care pathway in a large academic medical center. Although MR-guided SBRT is marginally more expensive than CT-guided SBRT, it boasts clear advantages, including avoidance of fiducial seed placement and improved dosimetry by virtue of limiting target margins. Future studies illustrating the magnitude of these clinical benefits are warranted to justify these increased costs.

Author Disclosure: N.R. Parikh: Employee; UCLA. P. Lee: Honoraria; Viewray. Commitee Co-Chair; Committee Co-Chair. S. Raman: None. M. Cao: None. J.M. Lamb: Consultant; ViewRay, INC. Member; Smart Cancer Centres Clinical Advisory Board. N. Agazaryan: Honoraria; Brainlab. Consultant; Brainlab. Travel Expenses; Brainlab. Chapter President; AAPM-SCC. M.L. Steinberg: Honoraria; Accuray. A. Raldow: None.

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