Room: AAPM ePoster Library
Purpose: To better understand radiotherapy costs in the developing world. Here we quantify the cost of human and facility resources required to deliver radiation therapy (RT) for locally advanced cervical cancer in public and private settings in a Latin American setting using time-driven activity-based costing (TDABC).
Methods: Workflows for treating locally advanced cervical cancer were studied in-person at a large public and a private center in Lima, Peru. Process maps were made representing each phase of care, which at both centers involved 25-fraction external beam radiotherapy followed by 2-fraction brachytherapy. These were verified by hospital leadership and supported by in-person interviews of multiple staff across each phase of care. For process times that varied by staff, sensitivity analyses were performed to reflect varying scenarios according to staff efficiency. Salary and equipment costs were obtained from administration to derive capacity cost rates (CCRs), which were multiplied by process times and summed to calculate total costs in Peruvian Nuevo Soles (PEN). Costs were converted to USD using conversation rates in January 2020.
Results: The total cost for the treatment of locally advanced cervical cancer in the public and private sector was $944.85 USD and $883.93 USD, respectively. For public, sensitivity analysis showed costs ranging from $942.11 UD to $947.59 USD, and for private, ranging from $845.04 USD to $922.82 USD. In public, representative CCRs include $0.28 USD/minute for physicians, $0.13 USD/minute for physicists, $2.20 USD/minute for linear accelerators, and $4.17 USD/minute for brachytherapy units. For private, these respective CCRs were $0.37 USD/minute, $0.20 USD/minute, $1.64 USD/minute, and $1.21 USD/minute.
Conclusion: Variability in staff efficiency with low CCRs has little bearing on overall costs of treatment. Brachytherapy and linear accelerator time are the most valuable resources per minute. This is the first report of TDABC to understand radiotherapy costs abroad.