The relative costs of proton and X-ray radiation therapy
The relative costs of proton and X-ray radiation therapy
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DOI：
10.1053/clon.2002.0174
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发表时间：
2003-02-01
影响因子：
3.4
通讯作者：
Jermann, M
中科院分区：
文献类型：
--
作者：
Goitein, M;Jermann, M
目的：研究调强质子治疗和调强X射线治疗的成本，以了解其相对差异。分析质子治疗的每一部分的成本的比率，每一部分的X-射线therapy.Materials和方法的成本：我们已经使用了一个计算机电子表格工具，其中大量的（通常为130）的输入参数表征一个特定的治疗方式可以被存储。从这些参数计算出多个导出变量，并且从这些导出变量可以计算出子系统的成本、整个设施、运行成本以及每部分和每次处理的成本。可以探索任何给定变量（例如成本/分数）对任何给定参数（例如设置时间）的灵敏度，以及相关置信区间的估计值。设施建设及设施营运之成本乃分开考虑。治疗设备成本（质子束治疗的主要成本）输入变量的关键数据由四个商业供应商提供。其他费用，如建筑和屏蔽费用或人员费用，则标准得多，我们的估计主要基于实际经验。我们考虑了两种情况：（1）两个设施在当前条件下运行;（2）未来的设施，其中可预见的提高效率和25%，减少成本的质子equipment.Results：目前的两个龙门质子设施的建设成本，完成设备，估计为62,500千电子当量和两个直线加速器的X射线设施在16,800千电子当量。在质子治疗的情况下，设施的运营成本被认为是占主导地位的，由商业成本（42% -主要是偿还设施建设的假定贷款的成本），人员成本（28%）和设备维修成本（21%）。对于X射线治疗，操作成本被视为主要由人员成本（51%）和业务成本（28%）。每部分的成本估计为质子1.025 kEE和X射线0.425 kEE-成本比为2.4 +/- 0.35（85%置信度）。在未来的设施中，这些成本可以分别降低到0.65 kEE和0.31 kEE，导致成本比为2.1。可以设想一些进一步的改进，这些改进可以将成本比率降低约20%。然而，如果最初的资本投资被“免除”，那么运营成本就不需要偿还投资，成本和成本比率都将大大降低。我们估计，在这种情况下，质子和X射线治疗的未来成本将分别为0.37千当量和0.23千当量，每部分成本比为1.6。这一比例也可能进一步降低20%。结论：复杂（即，强度调制）质子治疗现在并且可能继续比复杂的（即，强度调制）X射线治疗。目前的成本比率约为2.4，在未来5至10年内，很容易降至2.1，甚至可能降至1.7。如果不需要收回初始投资，成本比率将低得多，在1.6至1.3之间。质子束治疗的更高成本在临床上是否值得的问题是一个成本效益问题。本研究的目的是为这一比较的前一个分支做出贡献。(C)2002年皇家放射科医师学院。由爱思唯尔科技有限公司出版。保留所有权利。
Aim: To study the costs of intensity-modulated proton therapy and intensity-modulated X-ray therapy with the particular goal of understanding their relative differences. To analyse the ratio of the cost per fraction of proton therapy to the cost per fraction of X-ray therapy.Materials and methods: We have used a computer spreadsheet tool in which a large number (typically 130) of input parameters characterizing a particular therapeutic modality can be stored. From these parameters a number of derived variables are computed, and from these derived variables the costs of sub-systems, the entire facility, running costs and cost per fraction and per treatment can be computed. The sensitivity of any given variable (e.g. cost/fraction) to any given parameter (e.g. set-up time) can be explored, together with an estimate of the associated confidence interval. The costs of facility construction and facility operation are considered separately. Key data for the input variables regarding the cost of the therapy equipment (a dominant cost for proton beam therapy) were provided by four commercial vendors. Other costs, such as costs for building construction and shielding or personnel costs, are much more standard and our estimates were primarily based on practical experience. We considered two scenarios: (1) both facilities operating under current conditions; and (2) future facilities where foreseeable improvements in efficiency and a 25%, reduction in the cost of the proton equipment were assumed.Results: The construction cost of a current two-gantry proton facility, complete with the equipment, was estimated at 62,500 kEE and of a two-linac X-ray facility at 16,800 kEE. In the case of proton therapy the cost of operation of the facility was found to be dominated, by the business cost (42% - primarily the cost of repaying the presumed loan for facility construction), personnel costs (28%) and the cost of servicing the equipment (21%). For X-ray therapy, the cost of operation was seen to be dominated by the personnel cost (51%) and the business costs (28%). The costs per fraction were estimated to be 1.025 kEE for protons and 0.425 kEE for X-rays - for a ratio of costs of 2.4 +/- 0.35 (85% confidence). In a future facility these costs could be reduced to 0.65 kEE and 0.31 kEE respectively, leading to a ratio of costs of 2.1. A number of further improvements could be imagined which could reduce the ratio of costs by some 20%.If, however, the initial capital investment were 'forgiven,' so that the operating costs need not repay the investment, both the costs and the ratio of costs would be significantly less. We estimate that, under this condition, the future costs of proton and X-ray therapies would be 0.37 kEE and 0.23 kEE, respectively, for a cost-per-fraction ratio of 1.6. This ratio could also be susceptible to a further 20% reduction.Conclusions: Sophisticated (i.e., intensity-modulated) proton therapy is now, and is likely to continue to be, more expensive than sophisticated (i.e., intensity-modulated) X-ray therapy. The ratio of costs is about 2.4 at present and could readily come down to 2.1, and even, perhaps 1.7 over the next 5 to 10 years. If recovery of the initial investment is not required, the ratio of costs would be much lower, in the range of 1.6 to 1.3. The question of whether the greater cost of proton beam therapy is clinically worthwhile is a cost-effectiveness issue. The goal of this study is to contribute to the former arm of this comparison. (C) 2002 The Royal College of Radiologists. Published by Elsevier Science Ltd. All rights reserved.