title: Radiation therapy remains the key cost driver of oncology inpatient treatment.
abstract: OBJECTIVE
  Current radiation therapy capacities in Serbia and most of Eastern Europe are heavily lagging behind population needs. The primary study aim was assessment of direct costs of cancer medical care for patients suffering from cancer with assigned radiotherapy-based treatment protocols. Identification of key cost drivers and trends during 2010-2013 comparing brachytherapy and teleradiotherapy was a secondary objective of the study.
  
  
  METHODS
  Retrospective, bottom-up database analysis was conducted on electronic discharge invoices. Payer's perspective has been adopted with a 1-year long time horizon. Total sample size was 2544 patients during a 4-years long observation period (2010-2013). The sample consisted of all patients with confirmed malignancy disorder receiving inpatient radiation therapy in a large university hospital.
  
  
  RESULTS
  Diagnostics and treatment cost of cancer in the largest Western Balkans market of Serbia were heavily dominated by radiation therapy related direct medical costs. Total costs of care as well as mean cost per patient were steadily decreasing due to budget cuts caused by global recession. The paradox is that at the same time the budget share of radiotherapy increased for almost 15% and in value-based terms for €109 per patient (in total €109,330). Second ranked cost drivers were nursing care and imaging diagnostics. Costs of high-tech visualizing examinations were heavily dominated by nuclear medicine tests.
  
  
  CONCLUSIONS
  The budget impact of radiation oncology to the large tertiary care university clinics of the Balkans is likely to remain significant in the future. Brachytherapy exhibited a slow growth pattern, while teleradiotherapy remained stable in terms of value-based turnover of medical services. Upcoming heavy investment into the national network of radiotherapy facilities will emphasize the unsatisfied needs. Huge contemporary budget share of radiotherapy coupled with rising cancer prevalence brings this issue into the hot spot of the ongoing cost containment efforts by local governments.
authors.affiliation: Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac , Serbia.
authors.forename: Mihajlo
authors.initials: M
authors.lastname: Jakovljevic
authors.forename: Ana
authors.initials: A
authors.lastname: Zugic
authors.forename: Ana
authors.initials: A
authors.lastname: Rankovic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Dagovic
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000191:economics*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000532:radiotherapy* / Q000628:therapy; D012189:Retrospective Studies; D055771:Serbia; D017216:Telemedicine / Q000191:economics*; D014850:Waiting Lists
keywords: Cancer; Costs; Hospital; Inpatient; Malignant tumor; Radiation therapy; Serbia; Treatment