PURPOSE: Magnetic resonance-guided radiation therapy (MRgRT) has recently become commercially available, offering the opportunity to accurately image and target moving tumors as compared with computed tomography-guided radiation therapy (CTgRT) systems. However, the costs of delivering care with these 2 modalities remain poorly described. With localized unresectable hepatocellular carcinoma as an example, we were able to use time-driven activity-based costing to determine the cost of treatment on linear accelerators with CTgRT compared with MRgRT. MATERIALS AND METHODS: Process maps, informed via interviews with departmental personnel, were created for each phase of the care cycle. Stereotactic body radiation therapy was delivered at 50 Gy in 5 fractions, either with CTgRT using fiducial placement, deep inspiration breath-hold (DIBH) with real-time position management, and volumetric-modulated arc therapy, or with MRgRT using real-time tumor gating, DIBH, and static-gantry intensity-modulated radiation therapy. RESULTS: Direct clinical costs were $7,306 for CTgRT and $8,622 for MRgRT comprising personnel costs ($3,752 v $3,603), space and equipment costs ($2,912 v $4,769), and materials costs ($642 v $250). Increased MRgRT costs may be mitigated by forgoing CT simulation ($322 saved) or shortening treatment to 3 fractions ($1,815 saved). Conversely, adaptive treatment with MRgRT would result in an increase in cost of $529 per adaptive treatment. CONCLUSION: MRgRT offers real-time image guidance, avoidance of fiducial placement, and ability to use adaptive treatments; however, it is 18% more expensive than CTgRT under baseline assumptions. Future studies that elucidate the magnitude of potential clinical benefits of MRgRT are warranted to clarify the value of using this technology.
PURPOSE: Magnetic resonance-guided radiation therapy (MRgRT) has recently become commercially available, offering the opportunity to accurately image and target moving tumors as compared with computed tomography-guided radiation therapy (CTgRT) systems. However, the costs of delivering care with these 2 modalities remain poorly described. With localized unresectable hepatocellular carcinoma as an example, we were able to use time-driven activity-based costing to determine the cost of treatment on linear accelerators with CTgRT compared with MRgRT. MATERIALS AND METHODS: Process maps, informed via interviews with departmental personnel, were created for each phase of the care cycle. Stereotactic body radiation therapy was delivered at 50 Gy in 5 fractions, either with CTgRT using fiducial placement, deep inspiration breath-hold (DIBH) with real-time position management, and volumetric-modulated arc therapy, or with MRgRT using real-time tumor gating, DIBH, and static-gantry intensity-modulated radiation therapy. RESULTS: Direct clinical costs were $7,306 for CTgRT and $8,622 for MRgRT comprising personnel costs ($3,752 v $3,603), space and equipment costs ($2,912 v $4,769), and materials costs ($642 v $250). Increased MRgRT costs may be mitigated by forgoing CT simulation ($322 saved) or shortening treatment to 3 fractions ($1,815 saved). Conversely, adaptive treatment with MRgRT would result in an increase in cost of $529 per adaptive treatment. CONCLUSION: MRgRT offers real-time image guidance, avoidance of fiducial placement, and ability to use adaptive treatments; however, it is 18% more expensive than CTgRT under baseline assumptions. Future studies that elucidate the magnitude of potential clinical benefits of MRgRT are warranted to clarify the value of using this technology.
Authors: Neil R Parikh; Mary Ann Clark; Parashar Patel; Kayla Kafka-Peterson; Lalaine Zaide; Ting Martin Ma; Michael L Steinberg; Minsong Cao; Ann C Raldow; James Lamb; Amar U Kishan Journal: Appl Radiat Oncol Date: 2021-10-05
Authors: Paul J Keall; Caterina Brighi; Carri Glide-Hurst; Gary Liney; Paul Z Y Liu; Suzanne Lydiard; Chiara Paganelli; Trang Pham; Shanshan Shan; Alison C Tree; Uulke A van der Heide; David E J Waddington; Brendan Whelan Journal: Nat Rev Clin Oncol Date: 2022-04-19 Impact factor: 65.011
Authors: P Hoegen; K S Zhang; E Tonndorf-Martini; F Weykamp; S Regnery; P Naumann; K Lang; J Ristau; S A Körber; C Dreher; C Buchele; C Rippke; C K Renkamp; K M Paul; L König; C Büsch; J Krisam; O Sedlaczek; H-P Schlemmer; M Niyazi; S Corradini; J Debus; S Klüter; J Hörner-Rieber Journal: Radiat Oncol Date: 2022-03-27 Impact factor: 3.481
Authors: Alessandra Castelluccia; Pierpaolo Mincarone; Maria Rosaria Tumolo; Saverio Sabina; Riccardo Colella; Antonella Bodini; Francesco Tramacere; Maurizio Portaluri; Carlo Giacomo Leo Journal: Int J Environ Res Public Health Date: 2022-08-30 Impact factor: 4.614