title: Estimating the costs of intensity-modulated and 3-dimensional conformal radiotherapy in Ontario.
abstract: BACKGROUND
  Radiotherapy is a common treatment for many cancers, but up-to-date estimates of the costs of radiotherapy are lacking. In the present study, we estimated the unit costs of intensity-modulated radiotherapy (imrt) and 3-dimensional conformal radiotherapy (3D-crt) in Ontario.
  
  
  METHODS
  An activity-based costing model was developed to estimate the costs of imrt and 3D-crt in prostate cancer. It included the costs of equipment, staff, and supporting infrastructure. The framework was subsequently adapted to estimate the costs of radiotherapy in breast cancer and head-and-neck cancer. We also tested various scenarios by varying the program maturity and the use of volumetric modulated arc therapy (vmat) alongside imrt.
  
  
  RESULTS
  From the perspective of the health care system, treating prostate cancer with imrt and 3D-crt respectively cost $12,834 and $12,453 per patient. The cost of radiotherapy ranged from $5,270 to $14,155 and was sensitive to analytic perspective, radiation technique, and disease site. Cases of head-and-neck cancer were the most costly, being driven by treatment complexity and fractions per treatment. Although imrt was more costly than 3D-crt, its cost will likely decline over time as programs mature and vmat is incorporated.
  
  
  CONCLUSIONS
  Our costing model can be modified to estimate the costs of 3D-crt and imrt for various disease sites and settings. The results demonstrate the important role of capital costs in studies of radiotherapy cost from a health system perspective, which our model can accommodate. In addition, our study established the need for future analyses of imrt cost to consider how vmat affects time consumption.
authors.affiliation: St. Michael's Hospital, Toronto, ON;; Cancer Care Ontario, Toronto, ON;; Canadian Centre for Applied Research in Cancer Control, Toronto, ON;
authors.forename: J H E
authors.initials: JH
authors.lastname: Yong
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON;; The Cancer Centre Bahamas, Nassau, Bahamas;; The Cancer Centre Eastern Caribbean, St. John's, Antigua;
authors.forename: T
authors.initials: T
authors.lastname: McGowan
authors.affiliation: St. Michael's Hospital, Toronto, ON;; Cancer Care Ontario, Toronto, ON;; Canadian Centre for Applied Research in Cancer Control, Toronto, ON;
authors.forename: R
authors.initials: R
authors.lastname: Redmond-Misner
authors.affiliation: St. Michael's Hospital, Toronto, ON;; Cancer Care Ontario, Toronto, ON;; Canadian Centre for Applied Research in Cancer Control, Toronto, ON;
authors.forename: J
authors.initials: J
authors.lastname: Beca
authors.affiliation: Canadian Centre for Applied Research in Cancer Control, Toronto, ON;; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON;; Princess Margaret Hospital, University of Toronto, Toronto, ON.
authors.forename: P
authors.initials: P
authors.lastname: Warde
authors.affiliation: Cancer Care Ontario, Toronto, ON;
authors.forename: E
authors.initials: E
authors.lastname: Gutierrez
authors.affiliation: St. Michael's Hospital, Toronto, ON;; Cancer Care Ontario, Toronto, ON;; Canadian Centre for Applied Research in Cancer Control, Toronto, ON;; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
authors.forename: J S
authors.initials: JS
authors.lastname: Hoch
keywords: Radiotherapy; breast neoplasms; cost analyses; costs; head-and-neck neoplasms; intensity-modulated radiotherapy; prostate neoplasms