title: Cost Analysis of Complex Radiation Therapy for Patients With Head and Neck Cancer.
abstract: This cost analysis aimed to prospectively assess differences in costs between TomoTherapy and volumetric modulated arc therapy (VMAT) in patients with head and neck cancer.
  
  
  
  Economic data were gathered from a multicenter study. However, randomization was not possible due to the availability of equipment. Costs were calculated using the microcosting technique from the hospital's perspective (in 2013 euros), and the time horizon was radiation therapy. Only resources that entered the hospital production process and which were likely to vary between the strategies being compared were considered. Acute adverse events observed within the time horizon were also assessed.
  
  
  
  The cost analysis was based on a total of 173 patient treatments given between 2010 and 2012 in 14 French cancer centers: 73 patients were treated with TomoTherapy, 92 with VMAT RapidArc, and 8 with VMAT SmartArc. Estimated costs of SmartArc were removed from the comparison due to the small sample size. The mean ± SD cost per patient of the treatment planning phase was €314 (±€214) for TomoTherapy and €511 (±€590) for RapidArc. Mean costs ± SD per patient of irradiation reached €3144 (±€565) for TomoTherapy and €1350 (±€299) for RapidArc. The most sensitive parameter of irradiation was the annual operating time of accelerators. Ninety-five percent confidence intervals for the mean costs of irradiation were €3016 to €3272 for TomoTherapy and €1281 to €1408 for RapidArc. The number of acute adverse events during radiation therapy was not significantly different between strategies.
  
  
  
  TomoTherapy appeared to be more expensive than RapidArc mainly due to the higher price of the accelerator, the higher costs of maintenance, and the longer duration of treatment sessions. Because strategies were not significantly different in clinical effect, RapidArc appeared to be the strategy to be recommended at this stage of knowledge.
authors.affiliation: Univ Lyon, GATE-Unité Mixte de Recherche 5824-Centre national de la recherche scientifique, Lyon, France; Department of Clinical Research and Innovation, Leon Berard Cancer Centre, Lyon, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Perrier
authors.affiliation: Univ Lyon, GATE-Unité Mixte de Recherche 5824-Centre national de la recherche scientifique, Lyon, France; Department of Clinical Research and Innovation, Leon Berard Cancer Centre, Lyon, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Morelle
authors.affiliation: Department of Radiation Oncology, Leon Berard Cancer Centre, Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Pommier
authors.affiliation: Department of Radiation Oncology, Montpellier Cancer Institute, Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Boisselier
authors.affiliation: Department of Radiation Oncology, Oscar Lambret Cancer Centre, Lille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Coche-Dequeant
authors.affiliation: Department of Radiation Oncology, Clinique Pasteur, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Gallocher
authors.affiliation: Department of Radiation Oncology, Sainte Catherine Institute, Avignon, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Alfonsi
authors.affiliation: Department of Radiation Oncology, René Gauducheau Cancer Centre, Saint Herblain, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Bardet
authors.affiliation: Department of Radiation Oncology, Claudius Regaud Institute, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Rives
authors.affiliation: Department of Radiation Oncology, Curie Institute, Paris, France.
authors.forename: Valentin
authors.initials: V
authors.lastname: Calugaru
authors.affiliation: Department of Radiation Oncology, Eugène Marquis Cancer Centre, Rennes, France.
authors.forename: Enrique
authors.initials: E
authors.lastname: Chajon
authors.affiliation: Department of Radiation Oncology, Paul Strauss Cancer Centre, Strasbourg, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Noel
authors.affiliation: Lorraine Institute of Oncology, Vandoeuvre-lès-Nancy, France.
authors.forename: Hinda
authors.initials: H
authors.lastname: Mecellem
authors.affiliation: Department of Clinical Research and Innovation, Leon Berard Cancer Centre, Lyon, France.
authors.forename: David
authors.initials: D
authors.lastname: Pérol
authors.affiliation: Department of Clinical Research and Innovation, Leon Berard Cancer Centre, Lyon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Dussart
authors.affiliation: Department of Radiation Oncology, Paris Descartes University, Paris Sorbonne Cité, Hôpital Européen Georges Pompidou, Paris, France. Electronic address: philippe.giraud@aphp.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Giraud
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000191:economics*