title: The Technique, Resources and Costs of Stereotactic Body Radiotherapy of Prostate Cancer: A Comparison of Dose Regimens and Delivery Systems.
abstract: Robotic system has been used for stereotactic body radiotherapy (SBRT) of prostate cancer. Arc-based and fixed-gantry systems are used for hypofractionated regimens (10-20 fractions) and the standard regimen (39 fractions); they may also be used to deliver SBRT. Studies are currently underway to compare efficacy and safety of these systems and regimens. Thus, we describe the technique and required resources for the provision of robotic SBRT in relation to the standard regimen and other systems to guide investment decisions. Using administrative data of resource volumes and unit prices, we computed the cost per patient, cost per cure and cost per quality adjusted life year (QALY) of four regimens (5, 12, 20 and 39 fractions) and three delivery systems (robotic, arc-based and fixed-gantry) from a payer's perspective. We performed sensitivity analyses to examine the effects of daily hours of operation and in-room treatment delivery times on cost per patient. In addition, we estimated the budget impact when a robotic system is preferred over an arc-based or fixed-gantry system. Costs of SBRT were $6333/patient (robotic), $4368/patient (arc-based) and $4443/patient (fixed-gantry). When daily hours of operation were varied, the cost of robotic SBRT varied from $9324/patient (2 hours daily) to $5250/patient (10 hours daily). This was comparable to the costs of 39 fraction standard regimen which were $5935/patient (arc-based) and $7992/ patient (fixed-gantry). In settings of moderate to high patient volume, robotic SBRT is cost effective compared to the standard regimen. If SBRT can be delivered with equivalent efficacy and safety, the arc-based system would be the most cost effective system.
authors.affiliation: Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada Department of Oncology, McMaster University, Hamilton, ON, Canada Department of Medicine, Division of Oncology, Cape Breton Regional Cancer Centre, Sydney, NS, Canada Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada doc.sharieff@utoronto.ca.
authors.forename: Waseem
authors.initials: W
authors.lastname: Sharieff
authors.affiliation: Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Greenspoon
authors.affiliation: Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Dayes
authors.affiliation: Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors.forename: Tom
authors.initials: T
authors.lastname: Chow
authors.affiliation: Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Wright
authors.affiliation: Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors.forename: Himu
authors.initials: H
authors.lastname: Lukka
mesh_terms: D000230:Adenocarcinoma / Q000191:economics / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000191:economics / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D016634:Radiosurgery / Q000191:economics*; D012371:Robotics; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
keywords: Cost effectiveness; Hypofractionation; Prostate cancer; Stereotactic body radiotherapy