Can the Adoption of Hypofractionation Guidelines Expand Global Radiotherapy Access? An Analysis for Breast and Prostate Radiotherapy
Can the Adoption of Hypofractionation Guidelines Expand Global Radiotherapy Access? An Analysis for Breast and Prostate Radiotherapy
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DOI：
10.1200/jgo.19.00261
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发表时间：
2020-04-01
影响因子：
4.5
通讯作者：
Ngwa, Wilfred
中科院分区：
文献类型：
--
作者：
Irabor, Omoruyi Credit;Swanson, William;Ngwa, Wilfred
由于全球癌症控制的放射治疗资源有限，人们对开发节省时间和成本的创新以扩大这些资源的利用越来越感兴趣。大分割方案可以最大限度地降低成本，增加资源有限国家的可及性。在这项调查中，我们估计了在非洲国家采用低分割乳腺和前列腺放疗后，每个放疗疗程的成本节省百分比和增加的放疗机会。对于透视，结果进行了比较，与高收入countries.METHODS的成本和过程中的乳腺癌和前列腺放疗的常规和hypofractionated方案在低资源设施使用放射治疗成本估算工具由国际原子能机构（IAEA）开发的计算，然后与另一个活动为基础的成本模型进行比较。然后，使用全球癌症观测数据库中的癌症发病率数据，并采用使用率，估计每个国家在7年内乳腺和前列腺放疗的潜在最大成本节省。从IAEA directory.RESULTS的估计成本为每疗程的常规和hypofractionated方案为乳腺癌治疗的2，232美元和1，339美元，和3，389美元和1，699美元的前列腺治疗，分别增加了放射治疗的访问由当前的国家能力。在乳腺和前列腺治疗方面，完全实施低分割的预计潜在最大成本节约分别为11亿美元和6.06亿美元。由于实施hypofractionation的放疗访问的预计增加变化在+0.3%至25%and +0.4%至36.0%for breast and prostate treatments，either.CONCLUSION本次调查表明，采用hypofractionated方案作为标准治疗乳腺癌和前列腺癌可以导致大量的储蓄和增加放疗访问在发展中国家。考虑到降低的输送成本和治疗时间，我们预计随着更多的创新，放射治疗的可及性将大幅增加，这些创新将允许在不影响质量的情况下进行渐进式低分割。(C)2020年美国临床肿瘤学会
PURPOSE The limited radiotherapy resources for global cancer control have resulted in increased interest in developing time- and cost-saving innovations to expand access to those resources. Hypofractionated regimens could minimize cost and increase access for limited-resource countries. In this investigation, we estimated the percentage cost-savings per radiotherapy course and increased radiotherapy access in African countries after adopting hypofractionation for breast and prostate radiotherapy. For perspective, results were compared with high-income countries.METHODS The cost and course of breast and prostate radiotherapy for conventional and hypofractionated regimens in low-resource facilities were calculated using the Radiotherapy Cost Estimator tool developed by the International Atomic Energy Agency (IAEA) and then compared with another activity-based costing model. The potential maximum cost savings in each country over 7 years for breast and prostate radiotherapy were then estimated using cancer incidence data from the Global Cancer Observatory database with use rates applied. The increase in radiotherapy access was estimated by current national capacities from the IAEA directory.RESULTS The estimated cost per course of conventional and hypofractionated regimens were US$2,232 and $1,339 for breast treatment, and $3,389 and $1,699 for prostate treatment, respectively. The projected potential maximum cost savings with full hypofractionation implementation were $1.1 billion and $606 million for breast and prostate treatment, respectively. The projected increase of radiotherapy access due to implementing hypofractionation varied between +0.3% to 25% and +0.4% to 36.0% for breast and prostate treatments, respectively.CONCLUSION This investigation demonstrates that adopting hypofractionated regimens as standard treatment of breast and prostate cancers can result in substantial savings and increase radiotherapy access in developing countries. Given reduced delivery cost and treatment times, we anticipate a substantial increase in radiotherapy access with additional innovations that will allow progressive hypofractionation without compromising quality. (C) 2020 by American Society of Clinical Oncology