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Variable and fixed costs in NHS radiotherapy : consequences for increasing hypo fractionation

Katie Spencer, Noemie Defourny, David Tunstall, Viv Cosgrove, Karen Kirkby, Ann Henry, Yolande Lievens (UGent) and Peter Hall
(2022) RADIOTHERAPY AND ONCOLOGY. 166. p.180-188
Author
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Abstract
Background/Purpose: The increased use of hypofractionated radiotherapy changes department activity. While expected to be cost-effective, departments' fixed costs may impede savings. Understanding radiotherapy's cost-drivers, to what extent these are fixed and consequences of reducing activity can help to inform reimbursement strategies. Material/Methods: We estimate the cost of radiotherapy provision, using time-driven activity-based costing, for five bone metastases treatment strategies, in a large NHS provider. We compare these estimations to reimbursement tariff and assess their breakdown by cost types: fixed (buildings), semi-fixed (staff, linear accelerators) and variable (materials) costs. Sensitivity analyses assess the cost-drivers and impact of reducing departmental activity on the costs of remaining treatments, with varying disinvestment assumptions. Results: The estimated radiotherapy cost for bone metastases ranges from 430.95_ (single fraction) to 4240.76(sic) (45 Gy in 25#). Provider costs align closely with NHS reimbursement, except for the stereotactic ablative body radiotherapy (SABR) strategy (tariff exceeding by 15.3%). Semi-fixed staff costs account for 28.1-39.7% and fixed/semi-fixed equipment/space costs 38.5-54.8% of provider costs. Departmental activity is the biggest cost-driver; reduction in activity increasing cost, predominantly in fractionated treatments. Decommissioning linear accelerators ameliorates this, although can only be realised at equipment capacity thresholds. Conclusion: Hypofractionation is less burdensome to patients and long-term offers a cost-efficient mechanism to treat an increasing number of patients within existing capacity. As a large majority of treatment costs are fixed/semi-fixed, disinvestment is complex, within the life expectancy of a linac, imbalances between demand and capacity will result in higher treatment costs. With a per-fraction reimbursement, this may disincentivise delivery of hypofractionated treatments. (C) 2021 The Authors. Published by Elsevier B.V.
Keywords
Radiology, Nuclear Medicine and imaging, Oncology, Hematology, Radiotherapy, Hypofractionation, Cost, Economics, Time-driven activity-based costing, EXTERNAL-BEAM RADIOTHERAPY, PALLIATIVE RADIOTHERAPY, EUROPEAN COUNTRIES, RADIATION-THERAPY, IMPACT, TECHNOLOGIES, SERVICES, OUTCOMES

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MLA
Spencer, Katie, et al. “Variable and Fixed Costs in NHS Radiotherapy : Consequences for Increasing Hypo Fractionation.” RADIOTHERAPY AND ONCOLOGY, vol. 166, 2022, pp. 180–88, doi:10.1016/j.radonc.2021.11.035.
APA
Spencer, K., Defourny, N., Tunstall, D., Cosgrove, V., Kirkby, K., Henry, A., … Hall, P. (2022). Variable and fixed costs in NHS radiotherapy : consequences for increasing hypo fractionation. RADIOTHERAPY AND ONCOLOGY, 166, 180–188. https://doi.org/10.1016/j.radonc.2021.11.035
Chicago author-date
Spencer, Katie, Noemie Defourny, David Tunstall, Viv Cosgrove, Karen Kirkby, Ann Henry, Yolande Lievens, and Peter Hall. 2022. “Variable and Fixed Costs in NHS Radiotherapy : Consequences for Increasing Hypo Fractionation.” RADIOTHERAPY AND ONCOLOGY 166: 180–88. https://doi.org/10.1016/j.radonc.2021.11.035.
Chicago author-date (all authors)
Spencer, Katie, Noemie Defourny, David Tunstall, Viv Cosgrove, Karen Kirkby, Ann Henry, Yolande Lievens, and Peter Hall. 2022. “Variable and Fixed Costs in NHS Radiotherapy : Consequences for Increasing Hypo Fractionation.” RADIOTHERAPY AND ONCOLOGY 166: 180–188. doi:10.1016/j.radonc.2021.11.035.
Vancouver
1.
Spencer K, Defourny N, Tunstall D, Cosgrove V, Kirkby K, Henry A, et al. Variable and fixed costs in NHS radiotherapy : consequences for increasing hypo fractionation. RADIOTHERAPY AND ONCOLOGY. 2022;166:180–8.
IEEE
[1]
K. Spencer et al., “Variable and fixed costs in NHS radiotherapy : consequences for increasing hypo fractionation,” RADIOTHERAPY AND ONCOLOGY, vol. 166, pp. 180–188, 2022.
@article{8758477,
  abstract     = {{Background/Purpose: The increased use of hypofractionated radiotherapy changes department activity. While expected to be cost-effective, departments' fixed costs may impede savings. Understanding radiotherapy's cost-drivers, to what extent these are fixed and consequences of reducing activity can help to inform reimbursement strategies.

Material/Methods: We estimate the cost of radiotherapy provision, using time-driven activity-based costing, for five bone metastases treatment strategies, in a large NHS provider. We compare these estimations to reimbursement tariff and assess their breakdown by cost types: fixed (buildings), semi-fixed (staff, linear accelerators) and variable (materials) costs. Sensitivity analyses assess the cost-drivers and impact of reducing departmental activity on the costs of remaining treatments, with varying disinvestment assumptions.

Results: The estimated radiotherapy cost for bone metastases ranges from 430.95_ (single fraction) to 4240.76(sic) (45 Gy in 25#). Provider costs align closely with NHS reimbursement, except for the stereotactic ablative body radiotherapy (SABR) strategy (tariff exceeding by 15.3%). Semi-fixed staff costs account for 28.1-39.7% and fixed/semi-fixed equipment/space costs 38.5-54.8% of provider costs. Departmental activity is the biggest cost-driver; reduction in activity increasing cost, predominantly in fractionated treatments. Decommissioning linear accelerators ameliorates this, although can only be realised at equipment capacity thresholds.

Conclusion: Hypofractionation is less burdensome to patients and long-term offers a cost-efficient mechanism to treat an increasing number of patients within existing capacity. As a large majority of treatment costs are fixed/semi-fixed, disinvestment is complex, within the life expectancy of a linac, imbalances between demand and capacity will result in higher treatment costs. With a per-fraction reimbursement, this may disincentivise delivery of hypofractionated treatments. (C) 2021 The Authors. Published by Elsevier B.V.}},
  author       = {{Spencer, Katie and Defourny, Noemie and Tunstall, David and Cosgrove, Viv and Kirkby, Karen and Henry, Ann and Lievens, Yolande and Hall, Peter}},
  issn         = {{0167-8140}},
  journal      = {{RADIOTHERAPY AND ONCOLOGY}},
  keywords     = {{Radiology,Nuclear Medicine and imaging,Oncology,Hematology,Radiotherapy,Hypofractionation,Cost,Economics,Time-driven activity-based costing,EXTERNAL-BEAM RADIOTHERAPY,PALLIATIVE RADIOTHERAPY,EUROPEAN COUNTRIES,RADIATION-THERAPY,IMPACT,TECHNOLOGIES,SERVICES,OUTCOMES}},
  language     = {{eng}},
  pages        = {{180--188}},
  title        = {{Variable and fixed costs in NHS radiotherapy : consequences for increasing hypo fractionation}},
  url          = {{http://doi.org/10.1016/j.radonc.2021.11.035}},
  volume       = {{166}},
  year         = {{2022}},
}
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