Activity | Included costs | Cost drivers | |
---|---|---|---|
Time | Patient volume | ||
1. Consultation | Radiation oncologist | X | |
Nurse | X | ||
Gold seed insertiona | X | ||
2. CT simulation | Therapist | X | |
CT simulator | X | ||
Immobilizer | X | ||
Information system: patient management | X | ||
3. Dosimetry | Therapist | X | |
Planning system | X | ||
Radiation oncologist | X | ||
Information system: patient management | X | ||
4. Physics QA | Physicist | ||
Verify treatment plan | X | ||
Review data | X | ||
Physics associatesb | X | ||
Specialized QA equipmentb | X | ||
Planning system | |||
Information system: patient management | X | ||
5. Treatment QA and delivery, review visit | Therapist | ||
Pre-treatment | X | ||
On the unit | X | ||
Linear accelerator | X | ||
Radiation oncologist (review visit) | X | ||
Nurse (review visit) | X | ||
Information system: patient management | X | ||
Information system: record or verify | X |
Equipment | Annual cost ($) | Metrics | Unit cost ($) | |||||
---|---|---|---|---|---|---|---|---|
Acquisition and construction | Maintenance | Operating | Total | Operating hours per year (n) | Patients per year (n) | Per hour | Per patient | |
Linear accelerator | 471,312 | 40,097 | 417,317a | 928,725 | 2174b | 427 | ||
Incremental cost to support linear accelerator (IMRT) | -- | 55,361 | 55,361 | 2174b | 25 | |||
Treatment planning system | 415,755 | 41,575 | 457,330 | 2560c | 181 | |||
CT simulator | 300,267 | 23,097 | 323,365 | 1260 | 257 | |||
Information system: patient management | 271,172 | 27,117 | 58,900d | 357,190 | 1260 | 283 | ||
Information system: record or verify | 237,392 | 23,739 | 58,900d | 320,031 | 6522 | 49 | ||
Specialized QA equipment | 32,914 | 3,291 | 36,205 | 630e | 57 |
Activity | Resource | Hourly rate ($) | Hours (n) | Cost ($) | ||||
---|---|---|---|---|---|---|---|---|
3D-CRT | IMRT | Per patient | Per patient per activity | |||||
3D-CRT | IMRT | 3D-CRT | IMRT | |||||
Consultation | ||||||||
Radiation oncologist | 179 | 179 | 292 | 292 | ||||
Nurse | 113 | 113 | ||||||
Gold seed insertion | ||||||||
Gold seed | 117 | 117 | 117 | 117 | ||||
CT simulation | ||||||||
Radiation therapist | 84 | 2×0.5 | 2×0.5 | 84 | 84 | 426 | 426 | |
CT simulator | 257 | 257 | ||||||
Immobilizer | 14 | 14 | ||||||
Information system: patient management | 71 | 71 | ||||||
Dosimetry | ||||||||
Radiation therapist | 84 | 2.5 | 2.5 | 210 | 210 | 1,487 | 1,623 | |
Planning system | 181 | 2.5 | 2.5 | 454 | 454 | |||
Radiation oncologist | 752 | 888 | ||||||
Information system: patient management | 71 | 71 | ||||||
Physics QA | ||||||||
Physicist | 0.35 | 0.55 | 41 | 64 | 176 | 421 | ||
Physics associate | 86 | 0.75 | 129 | |||||
Specialized QA equipment | 57 | |||||||
Planning system | 181 | 0.35 | 0.55 | 64 | 99 | |||
Information system: patient management | 71 | 71 | ||||||
Treatment preparation and delivery, and review visits | ||||||||
Radiation therapist (pre-treatment) | 84 | 3.08a | 3.08a | 259 | 259 | 7,973 | 7,973 | |
Radiation therapist (treatment delivery) | 84 | 0.25×39×2.86b | 0.25×39×2.86b | 2,347 | 2,347 | |||
Linear accelerator | 427 | 0.25×39c | 0.25×39c | 4,166 | 4,166 | |||
Information system: patient management | 71 | 71 | ||||||
Information system: record or verify | 49 | 0.25×39c | 0.25×39c | 478 | 478 | |||
Review visits per patient (both protocols) | ||||||||
Radiation oncologist | 7 | 540 | 540 | |||||
Nurse | 113 | 113 | ||||||
Supporting infrastructure | 1,982 | 1,982 | ||||||
TOTAL COST | 12,453 | 12,834 |
Scenario | Time (hours) for .. | Cost for IMRT (2009 CA$) | |||
---|---|---|---|---|---|
Dosimetry | QA | Treatment | Total | Incremental | |
Base case | 2.50 | 0.5 | 9.75 | 12,834 | 381 |
Longer dosimetry time for IMRT | 3.75 | 13,166 | 713 | ||
Longer QA time for IMRT | 2.0 | 13,269 | 816 | ||
Longer dosimetry and QA time for IMRT | 3.75 | 2.0 | 13,601 | 1,148 | |
Adding VMAT to the processa | 6.50 | 10,679 | −1,773 | ||
Initial implementation of IMRTb | 6.00 | 4.0 | 13.00 | 16,720 | 4,268 |
25% higher cost of linear accelerator | 13,875 | 381 | |||
75% of cases using IMRTc | 12,815 | 362 |
Activity | Cost by cancer site ($) | |||||
---|---|---|---|---|---|---|
Head and neck | Breast | |||||
IMRT | 3D-CRT | Incremental | IMRT | 3D-CRT | Incremental | |
Consultation | 292 | 292 | -- | 292 | 292 | -- |
Gold seed insertion | -- | -- | ||||
CT simulation | 574 | 574 | -- | 426 | 426 | -- |
Dosimetry | 1,623 | 1,487 | 136 | 1,357 | 1,222 | 136 |
Physics QA | 491 | 220 | 271 | 203 | 146 | 57 |
Treatment preparation and delivery, and review visits | 9,193 | 7,980 | 1,213 | 4,592 | 4,592 | -- |
Supporting infrastructure | 1,982 | 1,982 | -- | 1,982 | 1,982 | -- |
TOTAL | 14,155 | 12,536 | 1,619 | 8,853 | 8,659 | 193 |
Activity | Cost by cancer site ($) | ||||||||
---|---|---|---|---|---|---|---|---|---|
Prostate | Head and neck | Breast | |||||||
IMRT | 3D-CRT | Incremental | IMRT | 3D-CRT | Incremental | IMRT | 3D-CRT | Incremental | |
Consultation | 113 | 113 | -- | 113 | 113 | -- | 113 | 113 | -- |
Gold seed insertion | 117 | 117 | -- | -- | -- | ||||
CT simulation | 133 | 133 | -- | 281 | 281 | -- | 133 | 133 | -- |
Dosimetry | 268 | 268 | -- | 268 | 268 | -- | 168 | 168 | -- |
Physics QA | 277 | 64 | 213 | 309 | 84 | 224 | 108 | 51 | 57 |
Treatment preparation and delivery, and review visits | 4,910 | 4,910 | -- | 5,799 | 5,015 | 785 | 2,823 | 2,823 | -- |
Supporting infrastructure | 1,982 | 1,982 | -- | 1,982 | 1,982 | -- | 1,982 | 1,982 | -- |
TOTAL | 7,802 | 7,588 | 213 | 8,753 | 7,744 | 1,009 | 5,328 | 5,270 | 57 |
Scenario | Time for .. | Cost for IMRT (2009 CA$) | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Dosimetry (hours) | QA (minutes) | Treatment (minutes) | Prostate | Head and neck | Breast | ||||||||||
Prostate | HN | Breast | Prostate | HN | Breast | Prostate | HN | Breast | Total | Incremental | Total | Incremental | Total | Incremental | |
Base case | |||||||||||||||
IMRT | 2.5 | 2.5 | 1.5 | 33 | 47 | 15 | 15 | 20 | 15 | 14,520 | 1,019 | 16,085 | 2,447 | 9,787 | 537 |
CRT | 2.5 | 2.5 | 1.5 | 21 | 30 | 15 | 15 | 17 | 15 | ||||||
Long dosimetry time (IMRT) | |||||||||||||||
IMRT | 3.75 | 3.75 | 2.25 | 15,151 | 1,650 | 16,716 | 3,078 | 10,165 | 916 | ||||||
Longer QA time (IMRT) | |||||||||||||||
IMRT | 120 | 120 | 60 | 15,303 | 1,802 | 16,742 | 3,104 | 10,190 | 941 | ||||||
Longer dosimetry and QA time (IMRT) | |||||||||||||||
IMRT | 3.75 | 3.75 | 2.25 | 120 | 120 | 60 | 15,934 | 2,433 | 17,373 | 3,735 | 10,569 | 1,320 | |||
VMATa | |||||||||||||||
IMRT | 10 | 17 | 12 | 12,077 | −1,424 | 14,949 | 1,311 | 9,060 | −189 | ||||||
CRT | 15 | 17 | 15 | ||||||||||||
Initial implementation of IMRTb | |||||||||||||||
IMRT | 6 | 6 | 6 | 240 | 240 | 240 | 20 | 25 | 20 | 20,389 | 6,888 | 21,963 | 8,325 | 13,417 | 4,168 |
CRT | 2.5 | 2.5 | 1.5 | 21 | 30 | 15 | 15 | 17 | 15 |
Item | Cost ($) | Expected lifespan (years) | |
---|---|---|---|
Acquisition | Construction | ||
Linear accelerator | 2,850,000 | 500,000 | 9 |
Treatment planning system with IMRT capabilitya | 1,800,000 | -- | 5 |
CT simulator | 1,000,000 | 300,000 | 5 |
Information system | 2,201,818 | -- | 5 |
Specialized QA equipment for IMRT | 142,500 | -- | 5 |
Cost centre | RT proportion (%) |
---|---|
Hospital administration | 15.5 |
Building service | 10.0 |
Security | 10.0 |
Laundry | 10.0 |
Medical records | 26.0 |
Porters | 60.0 |
Social work | 20.0 |
Clerical (RT) | 100.0 |
Clinical nutrition | 50.0 |
Utilities | 10.0 |
Clerical (registration) | 10.0 |
Housekeeping | 10.0 |
Activity | Resource | Disease site | |||||
---|---|---|---|---|---|---|---|
Prostate | Head and neck | Breast | |||||
3D-CRT | IMRT | 3D-CRT | IMRT | 3D-CRT | IMRT | ||
Gold seed insertion | Gold seed | Yes | Yes | Yes | Yes | No | No |
CT simulationa | Radiation therapist | 2×0.5 | 2×0.5 | 2×0.75 | 2×0.75 | 2×0.5 | 2×0.5 |
Dosimetry (hours) | Radiation therapist | 2.5 | 2.5 | 2.5 | 2.5 | 1.5 | 1.5 |
Planning system | 2.5 | 2.5 | 2.5 | 2.5 | 1.5 | 1.5 | |
Physics QA (hours) | Physicist | 0.35 | 0.55 | 0.50 | 0.78 | 0.25 | 0.25 |
Physics associate | 1.50 | 1.50 | |||||
Planning system | 0.35 | 0.55 | 0.50 | 0.78 | 0.25 | 0.25 | |
Treatment preparation and delivery | Radiation therapist (treatment delivery)b | 0.25×39×2.86 | 0.25×39×2.86 | 0.50×35×2.86 | 0.42×35×2.86 | 0.25×21×2.86 | 0.25×21×2.86 |
Linear acceleratorc | 0.25×39 | 0.25×39 | 0.50×35 | 0.42×35 | 0.25×21 | 0.25×21 | |
Information system (record or verify)c | 0.25×39 | 0.25×39 | 0.50×35 | 0.42×35 | 0.25×21 | 0.25×21 | |
Review visits (n) | Radiation oncologist and nurse | 7 | 5 | 5 |