J.M. Borras

HERO (Health Economics in Radiation Oncology): A Pan-European Project on Radiotherapy Resources and Needs

Radiotherapy continues to evolve at a rapid rate in technology and techniques, with both driving up costs in an era in which health care budgets are of increasing concern at every governmental level. Against this background, it is clear that the radiotherapy community needs to quantify the costs of state of the art practice and then to justify those costs through rigorous cost-effectiveness analyses. The European Society for Radiotherapy and Oncology-Health Economics in Radiation Oncology project is directed towards tackling this issue in the European context. The first step has been to provide a validated picture of the European radiotherapy landscape in terms of the availability of equipment, personnel and guidelines. An 84-item questionnaire was distributed to the 40 countries of the European Cancer Observatory, of which 34 provided partial or complete responses. There was a huge variation in the availability and sophistication of treatment equipment and staffing levels across Europe. The median number of MV units per million inhabitants was 5.3, but there was a seven-fold variation across the European countries. Likewise, although average staffing figures per million inhabitants were 12.8 for radiation oncologists, 7.6 for physicists, 3.5 for dosimetrists, 26.6 for radiation therapists and 14.8 for nurses, there was a 20-fold variation, even after grouping personnel with comparable duties in the radiotherapy process. Guidelines for capital and human resources were declared for most countries, but without explicitly providing metrics for developing capital and human resource inventories in many cases. Although courses delivered annually per resource item – be it equipment or staff – increase with decreasing gross national income (GNI) per capita, differences were observed in equipment and staff availability in countries with a higher GNI/n, indicating that health policy has a significant effect on the provision of services. Although more needs to be done to increase access to radiotherapy in Europe, the situation has improved considerably since the comparable RadioTherapy for Cancer: QUAnification of Infrastructure and Staffing Needs (QUARTS) study reported in 2005.

Cost calculation: a necessary step towards widespread adoption of advanced radiotherapy technology

ABSTRACT Radiotherapy costs are an often underestimated component of the economic assessment of new radiotherapy treatments and technologies. That the radiotherapy budget only consumes a finite part of the total cancer and healthcare budget does not relieve us from our responsibility to balance the extra costs to the additional benefits of new, more advanced, but typically also more expensive treatments we want to deliver. Yet, in contrast to what is the case for oncology drugs, literature evidence remains limited, as well for economic evaluations comparing new radiotherapy interventions as for cost calculation studies. Even more cumbersome, the available costing studies in the field of radiotherapy fail to accurately capture the real costs of our treatments due to the large variation in cost inputs, in scope of the analysis, in costing methodology. And this is not trivial. Accurate resource cost accounting lays the basis for the further steps in health technology assessment leading to radiotherapy investments and reimbursement, at the local, the national and the worldwide level. In the current paper we review some evidence from the existing costing literature and discuss how such data can be used to support reimbursement setting and investment cases for new radiotherapy equipment and infrastructure.

Differences in Treatment and Outcome of Pancreatic Adenocarcinoma Stage I and II in the EURECCA Pancreas Consortium

BackgroundThe EUropean REgistration of Cancer CAre (EURECCA) consortium aims to investigate differences in treatment and to improve cancer care through Europe. The purpose of this study was to compare neo- and adjuvant chemotherapy (ACT) and outcome after tumor resection for pancreatic adenocarcinoma stage I and II in the EURECCA Pancreas consortium.MethodsThe eight, collaborating national, regional, and single-center partners shared their anonymized dataset. Patients diagnosed in 2012–2013 who underwent tumor resection for pancreatic adenocarcinoma stage I and II were investigated with respect to treatment and survival and compared using uni- and multivariable logistic and Cox regression analyses. All comparisons were performed separately per registry type: national, regional, and single-center registries.ResultsIn total, 2052 patients were included. Stage II was present in the majority of patients. The use of neo-ACT was limited in most registries (range 2.8–15.5%) and was only different between Belgium and The Netherlands after adjustment for potential confounders. The use of ACT was different between the registries (range 40.5–70.0%), even after adjustment for potential confounders. Ninety-day mortality was also different between the registries (range 0.9–13.6%). In multivariable analyses for overall survival, differences were observed between the national and regional registries. Furthermore, patients in ascending age groups and patients with stage II showed a significant worse overall survival.ConclusionsThis study provides a clear insight in clinical practice in the EURECCA Pancreas consortium. The differences observed in (neo-)ACT and outcome give us the chance to further investigate the best practices and improve outcome of pancreatic adenocarcinoma.