title: [Economic assessment of pulsed dose-rate (PDR) brachytherapy with optimized dose distribution for cervix carcinoma].
abstract: OBJECTIVE
  Our study aims at evaluating the cost of pulsed dose-rate (PDR) brachytherapy with optimized dose distribution versus traditional treatments (iridium wires, cesium, non-optimized PDR). Issues surrounding reimbursement were also explored.
  
  
  METHODS
  This prospective, multicentre, non-randomised study conducted in the framework of a project entitled "Support Program for Costly Diagnostic and Therapeutic Innovations" involved 21 hospitals. Patients with cervix carcinoma received either classical brachytherapy or the innovation. The direct medical costs of staff and equipment, as well as the costs of radioactive sources, consumables and building renovation were evaluated from a hospital point of view using a microcosting approach. Subsequent costs per brachytherapy were compared between the four strategies.
  
  
  RESULTS
  The economic study included 463 patients over two years. The main resources categories associated with PDR brachytherapy (whether optimized or not) were radioactive sources (1053euro) and source projectors (735euro). Optimized PDR induced higher cost of imagery and dosimetry (respectively 130euro and 367euro) than non-optimized PDR (47euro and 75euro). Extra costs of innovation over the less costly strategy (iridium wires) reached more than 2100euro per treatment, but could be reduced by half in the hypothesis of 40 patients treated per year (instead of 24 in the study).
  
  
  CONCLUSIONS
  Aside from staff, imaging and dosimetry, the current hospital reimbursements largely underestimated the cost of innovation related to equipment and sources.
authors.affiliation: Université de Lyon, France. remonnay@lyon.fnclcc.fr
authors.forename: R
authors.initials: R
authors.lastname: Remonnay
authors.forename: M
authors.initials: M
authors.lastname: Morelle
authors.forename: P
authors.initials: P
authors.lastname: Pommier
authors.forename: C
authors.initials: C
authors.lastname: Haie-Meder
authors.forename: P
authors.initials: P
authors.lastname: Quetin
authors.forename: C
authors.initials: C
authors.lastname: Kerr
authors.forename: M
authors.initials: M
authors.lastname: Delannes
authors.forename: B
authors.initials: B
authors.lastname: Castelain
authors.forename: K
authors.initials: K
authors.lastname: Peignaux
authors.forename: Y
authors.initials: Y
authors.lastname: Kirova
authors.forename: P
authors.initials: P
authors.lastname: Romestaing
authors.forename: D
authors.initials: D
authors.lastname: Williaume
authors.forename: C
authors.initials: C
authors.lastname: Krzisch
authors.forename: L
authors.initials: L
authors.lastname: Thomas
authors.forename: P
authors.initials: P
authors.lastname: Lang
authors.forename: M H
authors.initials: MH
authors.lastname: Baron
authors.forename: A
authors.initials: A
authors.lastname: Cussac
authors.forename: F
authors.initials: F
authors.lastname: Lesaunier
authors.forename: S
authors.initials: S
authors.lastname: Maillard
authors.forename: I
authors.initials: I
authors.lastname: Barillot
authors.forename: C
authors.initials: C
authors.lastname: Charra-Brunaud
authors.forename: M-O
authors.initials: MO
authors.lastname: Carrère
authors.forename: D
authors.initials: D
authors.lastname: Peiffert
mesh_terms: D001918:Brachytherapy / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D002277:Carcinoma / Q000191:economics / Q000532:radiotherapy*; D002588:Cesium Radioisotopes / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007496:Iridium Radioisotopes / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies; D011874:Radiometry / Q000191:economics; D011879:Radiotherapy Dosage; D035703:Therapies, Investigational / Q000191:economics; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000532:radiotherapy*
chemical_list: D002588:Cesium Radioisotopes; D007496:Iridium Radioisotopes