Brachytherapy
is essential in the definitive management of many gynecological cancers,
including locally advanced cervical or vaginal cancers. However, brachytherapy
is underutilized in many parts of the world despite clear dosimetric and
survival advantages compared to even the most conformal EBRT techniques. Many
factors may be contributing to this, including the costs associated with
investing in new technology, training personnel and maintaining competency. In many
low and middle income countries where gynecologic cancers are among the most
common and most debilitating diseases, brachytherapy is not available at all
and the investment needed to
address this disparity is often perceived to be high and without economic
payback. In more developed parts
of the world, economic concerns about higher infrastructure and personnel costs
often constrain the transition from ‘one-size-fits-all’ 2D brachytherapy to
more conformal, image-guided techniques with the potential for improved tumor
control and fewer side effects.
Investment
in healthcare technology reflects a priority-setting process in which
governments and payers decide how to allocate scarce healthcare resources.
Economic evaluation provides decision-makers with common metrics to determine
the value for money of investment in one healthcare tool over another.
M. Milosevic
Princess Margaret Cancer Centre and
University of Toronto, Toronto, Canada
This presentation will review the economic evidence to
support investing in image-guided brachytherapy for gynecological cancer from
the perspective of patients, individual cancer treatment programs and the
healthcare payer, with a focus on the cost-effectiveness of MR-guided
brachytherapy for cervical cancer. The case will be made that best-practice MR-guided brachytherapy can be
economically attractive compared to CT-guided brachytherapy or 2D brachytherapy
by improving clinical outcomes and saving money. The path to scale-up of MR-guided brachytherapy in
Ontario, Canada by assisting
policy-makers with future infrastructure and human resource planning will be
outlined as a model that can be adapted to other jurisdictions and practice
settings.
D. Rodin, Princess Margaret Cancer Centre and
University of Toronto, Toronto, Canada
This
presentation will provide an overview of the different forms of economic
evaluation and health technology assessment tools and will apply these concepts
to brachytherapy. Drawing from the cervical cancer literature, it will use a
macroeconomic approach to healthcare investment and will review how
cost-benefit analyses can demonstrate the health and economic benefits of
radiotherapy in different resource settings. By viewing women with cancer as
productive members of the labour force and of their community, a strong
investment case for making brachytherapy available can be demonstrated to
decision-makers.