Time-Driven Activity-Based Costing Comparison of CT-Guided Versus MR-Guided SBRT

作者：Neil Rohit Parikh, Percy Lee, Steven S. Raman, Minsong Cao, James Lamb, Marguerite Tyran, Walter Chin, Travis Gilchrist, Nzhde Agazaryan, Kathryn Elizabeth Mittauer, Michael L. Steinberg, Ann Caroline Raldow · 发表于：JCO Oncology Practice · 年份：2020 · DOI：10.1200/jop.19.00605 · 被引用次数：40 · 研究领域：Advanced Radiotherapy Techniques、Hepatocellular Carcinoma Treatment and Prognosis、Radiation Therapy and Dosimetry

PURPOSE: Magnetic resonance-guided radiation therapy (MRgRT) has recently become commercially available, offering the opportunity to accurately image and target moving tumors as compared with computed tomography-guided radiation therapy (CTgRT) systems. However, the costs of delivering care with these 2 modalities remain poorly described. With localized unresectable hepatocellular carcinoma as an example, we were able to use time-driven activity-based costing to determine the cost of treatment on linear accelerators with CTgRT compared with MRgRT. MATERIALS AND METHODS: Process maps, informed via interviews with departmental personnel, were created for each phase of the care cycle. Stereotactic body radiation therapy was delivered at 50 Gy in 5 fractions, either with CTgRT using fiducial placement, deep inspiration breath-hold (DIBH) with real-time position management, and volumetric-modulated arc therapy, or with MRgRT using real-time tumor gating, DIBH, and static-gantry intensity-modulated radiation therapy. RESULTS: $250). Increased MRgRT costs may be mitigated by forgoing CT simulation ($322 saved) or shortening treatment to 3 fractions ($1,815 saved). Conversely, adaptive treatment with MRgRT would result in an increase in cost of $529 per adaptive treatment. CONCLUSION: MRgRT offers real-time image guidance, avoidance of fiducial placement, and ability to use adaptive treatments; however, it is 18% more expensive than CTgRT under baseline assumptions. Future studies th...