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Cost analysis of Gamma Knife stereotactic radiosurgery

Published online by Cambridge University Press:  01 October 2007

Alison Griffiths ,
Luke Marinovich ,
Michael B. Barton  and
Sarah J. Lord
Alison Griffiths
Affiliation:
The University of Sydney
Luke Marinovich
Affiliation:
The University of Sydney
Michael B. Barton
Affiliation:
University of New South Wales and Liverpool Hospital
Sarah J. Lord
Affiliation:
The University of Sydney
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Abstract

Objectives: Stereotactic radiosurgery (SRS) is used to treat intracranial lesions and vascular malformations as an addition or replacement to whole brain radiotherapy and microsurgery. SRS can be delivered by hardware and software appended to standard linear accelerators (Linacs) or by dedicated systems such as Gamma Knife, which has been proposed as a more accurate and user friendly technology. Internationally, dedicated systems have been funded, despite limitations in evidence. However, some countries including Australia have not recommended additional reimbursement for dedicated systems. This study compares the costs of Linac radiosurgery with Gamma Knife radiosurgery.

Methods: Due to limited evidence on comparative effects, the economic analysis was restricted to a cost evaluation. The base-case analysis assumed a modified Linac was used only to treat SRS patients. However, because a modified Linac could be used to treat other radiotherapy patients, a second analysis assumed spare time was used to meet other radiotherapy needs, and Linac capital costs were apportioned according to SRS use.

Results: The incremental cost of Gamma Knife versus a modified Linac was estimated as AU$209 per patient. This result is sensitive to variations in assumptions. A second analysis proportioning capital costs according to SRS use showed that Gamma Knife may cost up to AU$1673 more per patient.

Conclusions: Gamma Knife may be cost competitive only if demand for SRS services is high enough to fully use equipment working time. However, given low patient demand and competing radiotherapy needs, Gamma Knife appears more costly and further evidence of survival or quality of life advantages may be required to justify reimbursement.

Keywords

Stereotactic radiosurgeryGamma KnifeLinacCostEconomic
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 4 , October 2007 , pp. 488 - 494
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

1.AETMIS. Gamma Knife and linear accelerator stereotactic radiosurgery. Montreal: Agence d'evaluation des technologies et des modes d'intervention en sante (AETMIS); 2004.Google Scholar
2.Andrews, DW, Scott, CB, Sperduto, PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: Phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363:1665–1672.CrossRefGoogle ScholarPubMed
3.Barton, M, Frommer, M, Gabriel, G. An overview of cancer services in New South Wales. Sydney: CCore; 2004.Google Scholar
4.Commonwealth Department of Health and Ageing. Guidelines for the pharmaceutical industry on preparation of submissions to The Pharmaceutical Benefits Advisory Committee: Including major submissions involving economic analyses. Canberra: Commonwealth Department of Health and Ageing; 2002.Google Scholar
5.Elekta. Gamma Knife. Elekta Instruments internet web page. Available at: http://www.elektacom 2006. Accessed 17 May 2005.Google Scholar
6.Hailey, D.Stereotactic radiosurgery: An update. Edmonton: Alberta Heritage Foundation for Medical Research; 2002.Google Scholar
7.Hassen-Khodja, R. Gamma Knife and linear accelerator stereotactic radiosurgery. Montreal: Agence d'evaluation des technologies et des modes d'intervention en sante; 2002.Google Scholar
8.MSAC. Gamma Knife radiosurgery. Canberra: Commonwealth of Australia; 2001.Google Scholar
9.MSAC. Gamma Knife radiosurgery. Canberra: Commonwealth of Australia; 2006.Google Scholar
10.National Cancer Institute. Factsheet: Radiotherapy for cancer. National Cancer Institute: US national institute for health 25 May 2004. Available at: URL: http://www.cancer.gov/cancertopics/factsheet/Therapy/radiation. Accessed 20 April 2007.Google Scholar
11.NSW Health. 2004 Radiotherapy Management Information Systems Report. Sydney: NSW Health Department; 2005.Google Scholar
12.OECD. Purchase parity rates. OECD 2006. Available at: URL: http://www.oecd.org/department. Accessed 16 April 2007.Google Scholar
13.Ohinmaa, A.Cost estimation of stereotactic radiosurgery: Application to Albert. Edmonton: Alberta Heritage Foundation for Medical Research; 2003.Google Scholar
14.Oxford Centre for Evidence-based Medicine. Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001). Available at: http://www.cebm.net/levels_of_evidence.asp#levels. Accessed 11 April 2007.Google Scholar
15.Solberg, TD, Selch, M, Smathers, JB, et al. Fractionated stereotactic radiotherapy: rationale and methods. Med Dosim. 1998;23:209–219.CrossRefGoogle ScholarPubMed