Assessing value for radiotherapy options for spinal metastases

Abstract

Single-fraction spine stereotactic radiosurgery (SSRS-1) has a favourable resource-use profile for the treatment of spinal metastases compared with other radiation therapy (RT) options, such as 3-dimensional external beam RT (3D-RT) or intensity-modulated RT (IMRT). This is the main finding of a study that used timedriven activity-based costing (TDABC) methodology to compare the total resource use and relative costs of RT delivery for spinal metastases with SSRS (single-fraction [SSRS-1] to 18 Gy or 3-fraction [SSRS-3] to 27 Gy), 10-fraction 3D-RT to 30 Gy or 10-fraction IMRT to 30 Gy. The determination of personnel time was done through expert panel interviews. The analysis was conducted at a large academic cancer centre in the US. The analysis showed that personnel costs represented the vast majority for each care cycle, amounting to 93%, 88%, 75% and 79% of total costs for SSRS-1, SSRS-3, IMRT and 3D-RT, respectively. SSRS-3 was associated with the highest total costs (1% higher than IMRT, 17% higher than SSRS-1 and 34% higher than 3D-RT). The total costs of SSRS-1 were 17% higher than those for 3DRT and 16% lower than those for IMRT. The findings suggest favourable resource use with hypofractionated approaches. By shedding light on current institutional resource utilization, TDABC can help providers and administrators identify areas of operational inefficiency, optimize institutional workflows, and maximize valuedriven care delivery, conclude the researchers.