Accountability Of Resources And Cost For Different Modalities

Abstract

To evaluate feasibility in terms of cost for special treatment procedures across different modalities. An analysis of the cost of alternative state of the art treatment modalities was done to evaluate the necessity of more treatment options, compared to the financial gain provided by each. We used the 2019 Hospital Outpatient Prospective Payment System (HOPPS) to determine reimbursement for each treatment and assumptions on the time of physicist involvement, treatment planning, treatment time, time of radiation oncologist involvement (e.g. for gammaknife where the radiation oncologist stay during treatment), number of fractions per patient, average salaries and initial cost of modality and continuing cost of service contracts. We assumed one source exchange for gammaknife to extend its useful live. We did not include any existing overhead that will be the same between these modalities, rather just the cost of what is needed additionally for some modalities. We determined the maximum number of fractions that can be treated annually for each modality and the expected lifetime of each modality. We then calculated the number of patients needed annually to cover cost. For stereotactic radiosurgery modalities, i.e. CyberKnife, Linac-based, Linac/MRI, and gammaknife, the annual breakeven points were 25, 34, 41, and 74 patients respectively. For HDR the breakeven was 31 patients each year and 10 for a hyperthermia unit. For protons the number is higher with 152 patients. For each modality there is a limit on the number of patients that can be treated annually, depending on treatment time and common fractionations used for each modality. This favored Linac-based SRS and SBRT where the annual capacity was 1020 patients, because it was assumed that they are dedicated to stereotactic treatments, i.e. few fractions per patient and fastest treatment time. The annual capacity of patients treated with protons were 254, because of the assumption of 25 fractions per patient on average. For Gammaknife, CyberKnife, Linac/MRI, hyperthermia, and HDR the limits were 524, 331, 337, 104, and 433 respectively, because of long treatment times and/or planning times. Although hyperthermia needed the lowest number of patients to breakeven, its gain and limit on patient’s treated annually were the lowest because of a large need of physics and therapy time and relatively high service contracts. For large centers where there might be a larger number of patients that might benefit from a given modality, the cost can be reduced as staff gain more expertise to do these cases faster. Accountability for resources must be balanced by the number of patients that might benefit from it. Having more options of different modalities for state-of-the-art patient care might increase the potential number of patients and a center’s research potential, but it will also decrease the gain of each modality because of staff’s time, expertise, and service cost.