Cost Analysis And Profitability Of Total-Body Irradiation (Tbi): "Is The Game Worth The Candle For Radiation Oncology Departments?"

TBI is an important part of conditioning regimens prior to transplant in several hematologic malignancies including acute lymphoid leukemia (ALL). TBI has demonstrated better event-free-survival over chemotherapy regimens. Several TBI fractionated schedules have been described in the literature with higher time-machine consuming and human resources immobilization than standard treatments. From a cost point of view, the French public health system (HS) reimburse a fixed fee for CT-scan simulation and then for each fraction according to the technique used with an advantage for modern techniques. This study aimed to evaluate the shortfall in our department due to TBI as compared to the modern techniques. We collected data of standard treatments performed during one year on a linear accelerator (LA) simultaneously to TBI delivered using the second paired LA of the department. The first step of the analysis was to calculate the difference between total and per fraction reimbursements of the TBI versus other standard treatments delivered during the same using both LA. As the difference of reimbursements depends on the number of fractions and standard treatments (other than TBI) delivered in the same time and the total number of TBI delivered per year, we performed a probabilistic sensitivity analysis (PSA) with a Monte-Carlo simulation in which we drew 1 000 random values from a specified probability distribution for each parameter. In 2018, 14 TBI were delivered in 27 fractions using LA 1, while during the same time 99 fractions of alternative treatments were delivered by the LA 2. The annual shortfall for our department was 23 857€ (CI 95% [22 606€ – 25 108€]), and the shortfall per TBI treatment was 884€ (CI 95% [838€ - 931€]). In the PSA, the annual shortfall was 85 359€ (CI 95% [84 228€ - 86 489€]), and the per TBI shortfall was 1 647€ (CI 95% [1 632€ - 1 647€]). We also ran simulations in case of a single TBI regimen, and the results are reported in Table 1. While TBI is a major part of conditioning regimens, its reimbursement in France compared to conventional and modern treatments jeopardize its accessibility for patients, as radiation oncology departments are likely to favor other treatments for economic purpose. According to the French health system reimbursement, we demonstrated that TBI generates a significant shortfall in public radiation oncology department. A medico-economic assessment of the value of TBI, based on clinical data from the French National Registry, and analyses according to several health system perspectives are ongoing.Abstract 3047; Table 1Shortfall in 2018 euros95% Confidence IntervalInferiorSuperiorAnnual85,359.3384,228.9086,489.75Per TBI - all regimen included1,647.581,632.031,647.58Per TBI – 1 fraction544.59541.17548.01Per TBI – 3 fractions2,679.412,672.252,686.56Per TBI – 6 fractions6,620.946,600.976,640.92 Open table in a new tab