For prostate MR-guided adaptive radiotherapy
The Centre for Healthcare Innovation Research at the School of Health and Psychological Science, City, University of London welcomes Emma Xueto explore the costs and consequences of shifting the task of online contouring from clinicians to radiographers for patients receiving MRIgRT on the MRL for PCa, as part of the research seminar series.
Abstract
Prostate cancer (PCa) accounted for 23.2% of male cancers in Europe in 2020. More than 30% of PCa patients receive radical radiotherapy (RT). Advances in RT delivery which include image guided radiotherapy (IGRT) have been associated with improved outcomes.
Recently the MR-Linac (MRL) provides superior IGRT capabilities with the additional ability to replan the treatment daily through online adaptive MRI-guided radiotherapy (MRIgRT).
However, this involves the clinicians to be present at the time of treatment for the contouring of target volumes and organs at risk, which is resource and time intensive.
This study explores the costs and consequences of shifting the task of online contouring from clinicians to radiographers for patients receiving MRIgRT on the MRL for PCa.
Methods: A cost-consequence analysis was conducted using a discrete event simulation (DES) in Simul8 modelling the MRIgRT workflow.
The model was populated with workflow timing data from 15 patients undergoing a 20-treatment schedule (clinicians contouring 136 fractions, radiographers contouring 160), and 16 patients on a 5-treatment schedule (clinicians contouring 59 treatments, radiographers contouring 15).
Input parameters for the DES model were estimated through distribution fitting in R, with unit costs sourced from the PSSRU.
The analysis considered an annual cohort of 58 patients to reflect prostate radiotherapy referrals in a single department in 2022-23. An alternative cohort scenario of 55 patients (20-treatments) and 221 patients (5-treatments) was evaluated to represent the proportion of prostate patients able to be treated at maximum capacity in a year.
Results: Our model estimated cost saving of £108,311 for 20-treatment regimen and £24,440 in the 5-treatment regimen for a cohort of 58 patients.
Results show time savings of between 460 and 685 hours for 20-treatments and between 120 and 167 hours for 5-treatments. Under the alternative cohort scenario, there is a cost saving of £102,708 for 20 fractions and £92,745 for 5 fractions. Time savings ranged from 436 and 649 hours for 20-treatments and 457 and 637 hours for 5-treatments.
Conclusions: Implementing radiographer online contouring is cost saving and reduces the demand on clinician time. Our findings highlight the economic and efficiency benefits of this transition.
About the speaker
Emma Xue is a Research Assistant in Health Economic Evaluation.
She holds an MSc in International Health Policy (Health Economics) from LSE and has an interest in contributing towards cancer care through conducting economic evaluations in this area.
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