title: Robotic radiosurgery for the treatment of 1-3 brain metastases: a pragmatic application of cost-benefit analysis using willingness-to-pay.
abstract: With the emergence of radiosurgery as a new radiotherapeutic technique, health care decision makers are required to incorporate community need, cost and patient preferences when allocating radiosurgery resources. Conventional patient utility measures would not reflect short term preferences and would therefore not inform decision makers when allocating radiosurgery treatment units. The goal of this article is to demonstrate the feasibility of cost-benefit analysis to elicit the yearly net monetary benefit of robotic radiosurgery. To calculate the yearly incremental cost of robotic radiosurgery as compared to fixed gantry radiosurgery we used direct local cost data. We assumed a standard 10 year replacement and 5% amortization rate. Decision boards summarizing the clinical scenario of brain metastases and the difference between robotic and fixed gantry radiosurgery in terms of immobilization, comfort and treatment time were then presented to a sample of 18 participants. Participants who preferred robotic radiosurgery were randomly assigned to either a low ($1) or high ($5) starting point taxation based willingness-to-pay algorithm. The yearly incremental cost of providing robotic radiosurgery was $99,177 CAD. The mean community yearly willingness-to-pay for robotic radiosurgery was $2,300,000 CAD, p = 0.03. The calculated yearly net societal benefit for robotic radiosurgery was $2,200,823 CAD. Among participants who preferred robotic radiosurgery there was no evidence of starting point bias, p = 0.8. We have shown through this pilot study that it is feasible to perform cost-benefit analysis to evaluate new technologies in Radiation Oncology. Cost-benefit analysis offers an analytic method to evaluate local preferences and provide accountability when allocating limited healthcare resources.
authors.affiliation: Department of Oncology, Juravinski Cancer Centre Division of Radiation Oncology, McMaster University, Ontario, Canada. jeffrey.greenspoon@jcc.hhsc.ca.
authors.forename: Jeffrey Noah
authors.initials: JN
authors.lastname: Greenspoon
authors.forename: Anthony
authors.initials: A
authors.lastname: Whitton
authors.forename: Timothy
authors.initials: T
authors.lastname: Whelan
authors.forename: Waseem
authors.initials: W
authors.lastname: Sharieff
authors.forename: James
authors.initials: J
authors.lastname: Wright
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sussman
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D003362:Cost-Benefit Analysis; D006801:Humans; D007349:Insurance, Health, Reimbursement; D009864:Ontario; D016634:Radiosurgery / Q000191:economics; D012371:Robotics / Q000191:economics; D025321:Surgery, Computer-Assisted / Q000191:economics