ESTRO 2025 Congress Report I Interdisciplinary track

By 2050, global cancer incidence is projected to rise by 75% compared to 2022. Such growth will significantly increase the demand for radiotherapy and strain healthcare resources. To maintain sustainability and accessibility for all, strategic resource planning and robust health economic evaluations are essential. In 2019, ESTRO’s Health Economics in Radiation Oncology (HERO) project introduced a national-level cost-accounting tool that used time-driven activity-based costing to support resource planning and reimbursement in radiation oncology at the national level (Defourny et al., 2019).

In our department, we aimed to apply the HERO model to assess the impact of introducing online adaptive radiotherapy (oART). However, limitations in the model restricted its applicability at the institutional level and our ability to incorporate innovations into it. To address this, we systematically identified existing limitations, analysed their structural implications, and categorised them by model design, resource and their cost allocation, and innovation elements capture. Solutions were developed for each category, and this work led to a beta version of an upgraded, more adaptable HERO model.

Key enhancements, highlighted in Figure 1, include machine-specific costing and customisable operating hours, allowing for more accurate resource allocation. We also integrated offline and online adaptive radiotherapy workflows, expanding the model’s ability to assess a broader range of clinical indications. Additionally, we refined activity-time estimates based on key variables and defined delineation as a distinct step. Recognising the trade-off between detailed modelling and system-wide scope, we adopted a hybrid approach: broad system coverage combined with targeted granularity where it mattered most. This upgraded model supports both policy and local decision-making within a single framework, enabling more meaningful benchmarking of resource and economic evaluations in radiotherapy. The beta version marks an important step forward.

 

Figure 1: Diagram of the ESTRO HERO model structure with upgraded areas highlighted in green.

Future directions

This research lays the foundation for advancing the HERO model to become a more flexible and precise tool for cost evaluations in radiotherapy treatment. Advancing to a full 2.0 version will require broad collaboration and consensus within the radiotherapy community to ensure that the beta version is refined and validated to reflect real-world clinical practice. With these efforts, the HERO model could become a key instrument for resource planning, cost benchmarking, and the sustainable integration of innovations in radiotherapy across Europe and beyond.

Conclusion

This work marks an important step in advancing the HERO model for more precise, innovation-ready cost evaluations in radiotherapy. With the beta version, we can now investigate different scenarios of oART and their impact on cost and resources. The creation of a 2.0 version has the potential to become a key tool for resource and economic evaluations of radiotherapy treatments at both the policy and local levels.

References 

Defourny, Noemie et al. “National costs and resource requirements of external beam radiotherapy: A time-driven activity-based costing model from the ESTRO-HERO project.” Radiotherapy and Oncology 138 (2019): 187-194. 

Quentin Bouchez
Ghent University,
Faculty of Medicine and Health Sciences,
Department of Human Structure and Repair,
Ghent, Belgium 
Quentin.bouchez@ugent.be
https://www.linkedin.com/in/quentin-bouchez-1040b321b

 

Quentin Bouchez (right) received the Interdisciplinary Award from ESTRO President Matthias Guckenberger at ESTRO 2025