National costs and resource requirements of external beam radiotherapy: A time-driven activity-based costing model from the ESTRO-HERO project

Radiother Oncol. 2019 Sep:138:187-194. doi: 10.1016/j.radonc.2019.06.015. Epub 2019 Jul 15.


Background: The Health Economics in Radiation Oncology (ESTRO-HERO) project aims to provide a knowledge base for health economics in European radiotherapy. A cost-accounting model, providing data on national resource requirements and costs of external beam radiotherapy (EBRT), was developed.

Materials and methods: Time-driven activity-based costing (TD-ABC) was applied from the healthcare provider perspective at national level. TD-ABC allocates resource costs to treatment courses through the activities performed, based on time estimates.

Results: The model is structured in three layers. The central layer, EBRT-Core, accounts for EBRT care-pathway activities and follows TD-ABC allocation principles. Activities supporting radiation oncology (RO) (RO-Support) and multidisciplinary oncology (Beyond-EBRT) follow standard allocation principles. To demonstrate the model's capabilities, a dataset was constructed for the hypothetical country Europalia, based on published evidence on resources and treatments, whereas time estimates were expert opinions. Applying the TD-ABC model to this example, treatment delivery activities represent 68.4% of the costs; treatment preparation 31.6%. The cost per course shows large variation for different indications, techniques, and fractionation schedules, ranging between €838 and €7193. Resource utilization was estimated to be within the available capacity. Scenario analyses on changes in fractionation and treatment complexity are presented. The ESTRO-HERO TD-ABC tool can model EBRT costs and resource requirements. While the Europalia example illustrates its potential, the results cannot be generalized nor used as a proxy for national evidence. Only real-world data, tailored to the specificities of individual countries, will support National Radiation Oncology Societies with investment planning and access to innovative radiotherapy.

Keywords: Cost analysis; Healthcare provider perspective; Hospital Financial Management; Radiotherapy; Time-driven activity-based costing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Costs and Cost Analysis
  • Data Collection
  • European Union
  • Health Resources / economics
  • Humans
  • Models, Economic*
  • Neoplasms / economics
  • Neoplasms / radiotherapy*
  • Radiation Oncology / economics*
  • Radiotherapy / economics*
  • Radiotherapy / methods