Poster Presentation NSW State Cancer Conference 2023

Cost estimation of radiotherapy for local control and overall survival benefit of selected cancers in the pelvic region: Rectal cancers and cervical cancers (#202)

Jesmin Shafiq 1 2 3 , Vikneswary Batumalai 2 4 , Karen Wong 1 2 5 , Nasreen Kaadan 5 6 , Alexandra Powell 5 , Geoff P Delaney 1 2 3 5 , Shalini Vinod 1 2 3 5
  1. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool hospital, Liverpool, NSW, Australia
  2. School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
  3. Ingham Institute for Applied Medical Research , Liverpool , NSW, Australia
  4. GenesisCare, Sydney, NSW, Australia
  5. Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Sydney South West Local Health District, Liverpool, NSW, Australia
  6. SWSLHD Clinical Cancer Registry, Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia

Background
Optimal radiotherapy (RT) use in rectal and cervical cancers results in considerable 5-year local control (LC) and 5-year overall survival (OS) benefits at the population level: 13% LC and 4% OS benefits for rectal cancer, and 36% LC and 20% OS benefits for cervical cancer [1]. Our previous study assessed RT costs for outcomes that were $33,120 (LC) and $107,640 (OS) for rectal cancer, and $11,417 (LC) and $20,550 (OS) for cervical cancers [2]. The aim of this study was to estimate the cost of first RT course for rectal and cervical cancers and further explore the costs for LC and OS benefits by stage at diagnosis.
Methods
All RT activities for rectal and cervical cancers with curative and palliative intents were extracted from Liverpool Hospital electronic RT information system from 2017-18 to 2019-20 financial years. RT activities and associated costs were consolidated. Activity-based costing methods were applied based on the previous study [2] and adjusted for Reserve Bank of Australia inflation rates of the study period [3]. Average cost of treatment course was calculated (average cost per activity X no. of fractions). Cost per outcome ratios were estimated from cost of total fractions over 5-year and 1-year LC and OS gain for all stages and for stages I-II and stage III separately.
Results
12,234 RT activities for 160 rectal cancer patients and 3184 RT activities for 30 cervical cancer patients were recorded. Average RT course costs for rectal and cervical cancers were: $6,208 and $8,000 for all stages. The average costs over 5-year LC and OS gain for stages I-III rectal cancers were $28,608 and $92,657 respectively. Costs over outcomes for cervical cancers were: $15,780 for 5-year LC, and $28,370 for 5-year OS. For stages I-II versus stage III rectal cancers, the RT costs for one life-year gain were half ($3,068 vs $6,602) for LC and one–fourth ($6,136 vs $24,207) for OS. For cervical cancers stage I-II vs stage III, the cost outcomes ratios were similar: LC ($3,256 vs $2,052), OS ($4,350 vs $4,157).
Conclusions
Costs of RT fractionation schemes over LC/OS benefits for rectal and cervical cancers were comparable to previous estimates [2]. RT is an inexpensive treatment option and within the reported cost-effectiveness threshold for hearth services [4].

  1. Hanna T, Shafiq J, Delaney G, Vinod S, Thompson S, Barton M. The population benefit of evidence-based radiotherapy: 5-Year local control and overall survival benefits. Radiother Oncol 2017;126:191–97.
  2. Batumalai V, Wong K, Shafiq J, Hanna TP, Gabriel G, Heberle J, Koprivic I, Kaadan N, King O, Tran T, Cassapi L, Forstner D, Delaney GP, Barton M. Estimating the cost of radiotherapy for 5-year local control and overall survival benefit. Radiother Oncol. 2019 Apr 20;136:154-60.
  3. Reserve Bank of Australia Online calculator: https://www.rba.gov.au/calculator/financialYearDecimal.html.
  4. Owens DK. Interpretation of cost-effectiveness analyses. J Gen Intern Med. 1998 Oct;13(10):716-17.