ESTRO 2020 Abstract Book

S36 ESTRO 2020

Material and Methods Using open source data from World Bank, GLOBOCAN and the Directory of Radiotherapy Centers (DIRAC) from IAEA, we created a database of 190 countries with macro- economic (including GDP [Gross Domestic Product] and Health Expenditure) and other socio-economic indicators (including Human Development Index [HDI] and geographic population distribution), cancer incidence, mortality and the availability of radiotherapy equipment. A Time-Driven Activity Based Costing model was used to calculate the estimated costs of radiotherapy. Predictive Ordinary- Least-Squares (OLS) models were calculated to understand the factors affecting the availability of radiotherapy at country level (measured by the number of megavoltage [MV] units per million population and per 1000 cancer cases). Cut-off values for significant independent variables were obtained by Receiver Operating Characteristic (ROC) curve analysis. Results During the last decade the worldwide number of MV units per million population increased by 49.13%, but the variation in the number of MV units per 1000 cancer cases decreased by 11.9% (table 1). Estimated capital costs per capita and operational costs per year per capita (in current US$) of the installed capacity in 2018 were 4.95 US$ and 1.40 US$. Then, we calculated additional costs for up-scale to full coverage: the additional capital costs per capita were 1.92 US$; and the final operational costs per year per capita were 1.53 US$. OLS models identified a strong association between the provision of radiotherapy services at a country level and (1) some economic indicators (GDP and health expenditure), (2) the population distribution (proportion of urban vs. rural population) and (3) the ratio of the estimated operational costs of radiotherapy to the total expenditure in health (table 2).

models explains between 60 and 66% of the variance in the dependant variables, suggesting than more explanatory value can be still gained by including other variables. Our group continues to work on the refinement of these findings to provide guidance for investment in radiotherapy. OC-0078 A Cost-effectiveness of Different Approaches to the Treatment of Localized Prostate Cancer OC-0079 Can SABR for painful bone metastases ever be cost-effective in the NHS? K. Spencer 1 , C. Bojke 1 , A. Henry 2 , G. Velikova 2 , E. Morris 3 , Y. Van der Linden 4 , W. Van den Hout 5 , P. Hall 6 1 University of Leeds, Leeds Institute of Health Sciences, Leeds, United Kingdom ; 2 University of Leeds, Leeds Institute of Medical Research, Leeds, United Kingdom ; 3 University of Leeds, Leeds Institute of Data Analytics, Leeds, United Kingdom ; 4 Leiden University Medical Centre, Radiotherapy department, Leiden, The Netherlands ; 5 Leiden University Medical Centre, Health Economics, Leiden, The Netherlands ; 6 Edinburgh University, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom Purpose or Objective Higher rates of re-irradiation following single fraction conventional radiotherapy have led to persistent views that dose-escalation might result in better quality and durability of pain control. Single centre series and an early phase trial have demonstrated high rates of complete pain response and durability following stereotactic radiotherapy (SABR). SABR is, however, markedly more expensive than conventional radiotherapy. This study aimed to assess if SABR for painful bone metastases could ever be cost-effective in the English National Health Service (NHS). Material and Methods A Markov decision model was developed to model costs (in 2016 £ sterling) and benefits associated with SABR as compared to single 8Gy conventional palliative radiotherapy. Four pain response states were included, in line with the International Consensus on Palliative Radiotherapy Endpoints (ICPRE). Re-irradiation could occur where pain persisted and death was an absorbing state which could be reached from all pain response states. A life-time horizon was modelled with a cycle length of 1 week. Model parameters were informed using data from the Dutch Bone Metastases Study, literature review and NHS reference costs. Response to SABR was informed based on the outcomes of Sprave et al. One way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model parameters.Specific focus was placed upon the impact of plausible changes in the survival of the treated cohort and treatment costs. Results SABR treatment resulted in an average QALY gain of 0.056 with associated incremental costs of £3125 for a three fraction course. At a willingness to pay threshold of £30,000/QALY the incremental cost-effectiveness ratio (ICER) for SABR was £55,592/QALY with a probability of 4% that SABR was the most cost-effective strategy. In a population with a median survival of 53 weeks, the ICER dropped to £39,200/QALY. Similarly, recognising a plausible long-term cost of treatment, beyond an initial implementation period, resulted in a fall to £28,431/QALY. Where these long-term costs were considered in a population with prolonged survival the ICER dropped markedly to £17,889/QALY with SABR having an 80.6% probability of being cost-effective. Conclusion Abstract withdrawn from presentation

Conclusion Our findings support the well-known strong association between national radiotherapy capacity and macroeconomic indicators of national wealth and development, but also gives insight on other factors that have been hidden in previous analysis as the geographic distribution of the population (urban population) or not previously reported like the ratio of estimated operational costs in radiotherapy (as a proxy for expenditure in radiotherapy) to total expenditure in health. The fit of our