Radiotherapy utilisation in lung cancer in New Zealand: disparities with optimal rates explained.
OBJECTIVE
The intervention rate (IR) of radiotherapy (RT) is important for health service planning. As actual IRs are commonly lower than those predicted by models, we sought to determine the reasons for this discrepancy, using lung cancer in a mixed urban-rural region of New Zealand (NZ).


METHODS
The appropriate utilisation of RT was calculated as the sum of the actual utilisation 3 years post diagnosis (88% of cases deceased), the estimated utilisation of the 12% remaining alive, and the percentage of cases that may have benefited from RT but did not receive it.


RESULTS
The actual utilisation was estimated as 43% (range 40-48%). A further 8% of deceased cases may have benefitted from RT (but were not referred), giving an appropriate utilisation of 51%. An additional 3.5% that may have benefitted from RT declined management. The difference from modelled IRs was due to a combination of early mortality, refusal of treatment and assumed higher RT treatment rates for many clinical scenarios.


CONCLUSIONS
The appropriate utilisation of RT was substantially lower than IRs derived from models. The assumptions from which these models were derived may result in over-estimates for resource planning purposes.
Department of Oncology, Auckland Hospital, Park Rd, Grafton, Auckland, New Zealand. gstevens@adhb.govt.nz
Graham
G
Stevens
Wendy
W
Stevens
Sudha
S
Purchuri
John
J
Kolbe
Brian
B
Cox
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016009:Chi-Square Distribution; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009367:Neoplasm Staging; D009520:New Zealand; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D011336:Probability; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012424:Rural Population; D016019:Survival Analysis; D014505:Urban Population