[Benefit assessment by the Federal Joint Committee: assessment of treatment strategies for low risk prostate cancer]. / Vergleichende Nutzenbewertungen im Gemeinsamen Bundesausschuss : Unterschiedliche Therapieansätze beim Prostatakarzinom mit niedrigem Risiko.

One of the Federal Joint Committee's duties is to assess benefit, need, and cost-effectiveness of diagnostic and therapeutic approaches. The aim is to decide whether they can be provided within the statutory health care system in Germany. The systematic assessment concerning low dose rate brachytherapy with permanent seed implantation for treatment of men with localized prostate cancer revealed that sufficient scientific evidence for its benefit compared to therapeutic alternatives is still missing. In 2009, the Federal Joint Committee recommended a randomized controlled trial in order to evaluate the different therapies. Based on a concept developed by the National Association of Statutory Health Insurance Funds urology and radiooncology experts and other protagonists are currently working on the steps to be taken for implementation of a preference-based randomized controlled trial to compare radical prostatectomy, percutaneous radiotherapy, low dose rate brachytherapy with permanent seed implantation, and active surveillance in the treatment of low or early intermediate risk prostate cancer.

Multinational assessment of some operational costs of teletherapy.

BACKGROUND AND PURPOSE: Decisions in planning radiotherapy facilities in countries with limited financial resources require information on economic factors to make provision for sustainability. This study aims at acquiring data on some of these factors involved in delivery of teletherapy in 11 countries of different economic status. PATIENTS AND METHODS: Representatives of three European, one African, three Latin American and four Asian countries, were identified from radiation oncology institutions that operated both cobalt and linac teletherapy machines. Productivity data were prospectively collected for the year 2002. A detailed log was recorded for each machine over an arbitrary two-week period. Data on quality assurance (QA), maintenance, the capital costs of each machine, and the source replacement costs for the cobalt units were also recorded. RESULTS: Both linear accelerators and cobalt machines treat more than 10,000 fractions per year per machine with 2.5 and 2.3 fields per fraction, respectively. The capital costs of the machines vary considerably, with a factor of more than 10 for linear accelerators. Cobalt sources show a huge variation in price. The median costs of QA and maintenance of a linac was US$ 41,000 compared to US$ 6000 for cobalt machines. This results for the economic factors considered in median costs per fraction of US$ 11.02 for linear accelerators and US$ 4.87 for cobalt machines. These figures do not include the costs for physicians. CONCLUSIONS: The variation of the costs per fraction is more due to the result of differences in machine usage and costs of equipment than of national economic status. A treatment fraction on a linac with functionality comparable to cobalt, costs 50% more than cobalt therapy. This project shows that it is possible to collect data on economic factors prospectively as well as retrospectively.

A cost-outcome analysis of long-term adjuvant goserelin in addition to radiotherapy for locally advanced prostate cancer.

To quantify the incremental costs and outcomes of using long-term adjuvant goserelin in addition to radiotherapy for locally advanced prostate cancer. The cost of radiotherapy for prostate cancer has been calculated using an activity-costing model. The total cost of administering adjuvant hormonal therapy for 3 years is based on local pharmacy charges plus typical physician billing fees and additional laboratory costs. Outcome data were obtained from the published EORTC 22,863 randomized trial comparing treatment of locally advanced prostate cancer with radiotherapy alone or in combination with 3 years of adjuvant goserelin. Using this information, the cost-effectiveness of adjuvant goserelin was calculated and expressed in terms of dollars per life-years (LY) gained. The total institutional costs of radiotherapy are $9000 Cdn. and the additional costs of providing adjuvant goserelin for 3 years are approximately $19,800 CDN. The improvement in outcome with the use of adjuvant goserelin was estimated to be 1.2 LY per patient treated, giving a cost-effectiveness ratio of $16,500 Cdn ($11,000 US) per LY from an institutional perspective. Our sensitivity analysis confirms the robustness of our findings since even in our "worst case" scenario the cost-effectiveness ratio was estimated to be $21,600 Can ($14,400 US) per LY gained. This figure is still below $50,000 US per LY gained which is the quoted current standard for cost-effectiveness. This analysis demonstrates that the use of long-term adjuvant goserelin for locally advanced prostate cancer provides substantial benefit at an acceptable cost.

Europium-152 as a potential substitute for cobalt-60 in radiation therapy.

Construction has begun of prototype europium-152 sources, with the principal goal of providing cost-effective teletherapy for emergent nations where prices for cobalt-60 are excessive, owing to replacement needs, and the use of linacs is economically prohibitive and technologically unfeasible. 152Eu sources (T1/2 = 13.4y vs T1/2 = 5.26y for 60Co) are designed for absorbed dose rates > 1.5 Gy/min at 1 m, with specific activities > 5 TBq/gm, allowing substitution into existing irradiators. Costs of 152Eu compare favorably with 60Co, taking account of extended useful lifetime.

Radiation oncology: quality assurance and cost-effectiveness in Australia.

The purpose of this study was to develop a data set consisting of measures of treatment outcome and cost, capable of standardization across radiation oncology facilities in Australia. Using a detailed consultative process involving representatives of a wide variety of professional organizations including the Royal Australasian College of Radiologists, the study identified the items necessary for inclusion in a data collection instrument to allow assessment of treatment modalities, quality of care, comparative efficiency and cost-effectiveness of radiation oncology services. The instrument has been tested by a pilot study and the results indicate that the items included in the instrument have received acceptance amongst health care providers.

[An economic analysis of gamma teletherapy]. / Ekonomicheskii analiz distantsionnoi gamma-terapii.

The paper is concerned with comparative economic analysis of different types of organization of teletherapy. Considerable economic advantages of the operation of teletherapy units in 2 shifts as compared to that in one shift and a 7-day schedule as compared to a 5-day schedule were shown. Using economic reserves, one can considerably expand the volume of radiological service without great extra expenditures.