Main Session

Sep 30

PQA 09 - Hematologic Malignancies, Health Services Research, Digital Health Innovation and Informatics

3614 - MR-Linac-Based Adaptive and Non-Adaptive SBRT for Prostate and Pancreatic Cancer vs. Conventional-Linac-Based Treatment: A Time-Driven Activity-Based Costing Analysis

04:00pm - 05:00pm PT

Hall F

Screen: 24

POSTER

Presenter(s)

Zachary Feldt, BS - University of Virginia, Charlottesville, VA

Z. Feldt¹, M. Mistro², E. Janowski³, C. Luminais⁴, and C. McLaughlin⁵; ¹University of Virginia, Charlottesville, VA, ²University of Virginia Department of Radiation Oncology, Charlottesville, VA, ³University of Virginia, Department of Radiation Oncology, Charlottesville, VA, ⁴Department of Radiation Oncology, University of Virginia, Charlottesville, VA, ⁵Department of Radiation Oncology, University of Virginia Health, Charlottesville, VA

Purpose/Objective(s):

Numerous radiation therapy modalities are available for treating cancers of the abdomen and pelvis, and the advent of MR-linear accelerators (linacs) has added yet another option. However, the differences in true cost between MR-linac-based treatments and conventional options have not been extensively reported. We sought to compare the costs between conventional linac-based intensity-modulated radiation therapy (IMRT), conventional linac-based stereotactic body radiation therapy (SBRT), and MR-linac-based SBRT in both the adaptive and non-adaptive settings. Our hypothesis is that prostate and pancreatic cancer treatments using MR-linac adaptive SBRT will be significantly more expensive than their respective conventional-linac-based treatment courses, due to the cost of machinery and complexity of treatment delivery.

Materials/Methods:

Direct costs were calculated using a Time-Driven Activity-Based Costing (TDABC) model. This was performed through the application of cost data for space, equipment, personnel, and material to process maps representative of the treatment plans. Process maps for each appointment type of each treatment plan were created using direct measurements and staff interviews. Cost capacity was then determined from departmental and institutional data of machine, room, equipment, and personnel costs. These costs were converted into a cost per unit time, allowing for the overall costs of each treatment plan to be determined.

Results:

We determined the following total costs per treatment episode: for conventional linac-based SBRT for prostate, this was $7,748.68, and for MR-linac SBRT it was $11,169.61 for nonadaptive versus $14,813.26 for adaptive (91% higher than conventional). For pancreas, we found that conventional linac IMRT was $5,305.35 versus $3,685.48 for SBRT on a conventional linac. However, the cost of MR-linac adaptive SBRT for pancreas was $13,636.36 (270% higher than conventional SBRT). For both prostate and pancreas, the added costs of MR-linac treatments (especially adaptive treatment) were primarily due to the significantly higher machine time and personnel costs per case treated.

Conclusion:

Determination of the true cost of treatment is the first step to the appropriate use of new, limited technologies. The difference in patient outcomes associated with each of these treatments could be used to further determine the cost effectiveness of each treatment type and to guide the treatments offered to patients in the future. In addition, these TDABC analyses can hopefully guide workflow efficiencies to improve cost effectiveness over time.