ESTRO 36 Abstract Book

164 / 1082

S151 ESTRO 36 2017
_______________________________________________________________________________________________
prognosis significantly superior than HPV negative
tumor.Although their survival is excellent, standard RT-CT
regimens produce substantial that scenario
strategies for de-intensification have been -
intensification is to modify the standard treatment in
order to reduce the long-termtoxicities associated with
radiation / chemotherapy while maintaining the high cure
rates.Prognostic factors allow us to select patients with
excellent outcomes that can benefits from de-
intensification strategies. This factors are: Oropharyngeal
cancer, P16 +, minimalsmoking history, non bulky primary
and non-extensive nodal spread (not N2c-N3).Strategies
for de-intensification are: Select chemo responders and
reduce RT dose or thevolume, reduce RT dose and
cisplatin, replace cisplatin with cetuximab, use
TORSresection and reduce adjuvant RT dosePublished de-
escalation clinical trial will be presented and discussed as
well as the mostimportant ongoing conclusions:
radiation de-escalation is experimental and should be
conducted in clinicaltrials, appropriate candidates for de-
escalation are well defined, there are differentstrategies
for de-intensification, preliminary data show efficacy but
the effect on long-termtoxicity reduction need to be
proved.
Symposium with Proffered Papers: Costs and value of
radiotherapy innovations: how to assess
SP-0294 Health Technology Assessment: what’s in a
word?
A. Aggarwal1
1 London School of Hygiene and Tropical Medicine, Health
Services Research and Policy, London, United Kingdom
Health Technology Assessments (HTA) aim to ensure
rational and fair decisions are made on resource allocation
for new health interventions. The advantage of HTAs are
their universality when making decisions regarding which
treatments across all medical specialities represent the
best value to society. However, few if any countries
internationally use HTA in the evaluation of radiation
technologies. Instead these processes have largely
focussed on new cancer drugs, informing reimbursement
policy for public health systems.
In the absence of HTA processes, low regulatory barriers
have resulted in the relentless diffusion of increasingly
expensive radiotherapy innovations which offer ever-
marginal gains in the therapeutic ratio. Without a rational
and evidence based approach to evaluation the costs of
delivering cancer care will continue to rise exponentially.
I will discuss how a commitment to HTA processes is
imperative in order to avoid many of the entrenched
interests and inefficient practices that have manifest in
high income countries due to differences in cancer care
delivery, and health system financing. I will also highlight
the challenges in establishing HTA for radiotherapy
interventions, given the diversity in innovation, and
limitations within the evidence base to enable
comparative effectiveness research.
In addition I will offer insights into the challenges of
implementing HTA decisions in practice, using the
experiences of the UK National Institute for Health and
Clinical Excellence (NICE) as an example. Specifically, the
impact of political, public and media pressure on HTA
assessments of cancer therapies as well as the negative
consequences of bypassing these value driven approaches
to reimbursement policy.
SP-0295 Radiotherapy costs: the good, the bad and the
ugly
L.Perrier
5 Cancer Centre Léon Bérard, Clinical Research and
Innovation Direction, Lyon, France
Abstract not received
OC-0296 A critical quality appraisal of studies
estimating the cost of radiotherapy
N. Defourny1, P. Dunscombe2, C. Grau3, Y. Lievens4, L.
Perrier5
1ESTRO A.I.S.B.L., HERO, Brussels, Belgium
2University of Calgary, Department of Oncology, Calgary,
Canada
3Aarhus University, Department of Clinical Medicine,
Aarhus, Denmark
4University Hospital Ghent, Radiation Oncologist, Ghent,
Belgium
5Cancer Centre Léon Bérard, Clinical Research and
Innovation Direction, Lyon, France
Purpose or Objective
In the context of growing healthcare expenses combined
with reduced economic growth, health economics (HE)
studies are becoming paramount. Considerable interest in
the domain is apparent when looking at the number of
articles indexed with HE keywords. Nevertheless, a recent
literature review has revealed very few articles
calculating the cost of radiotherapy, and a large
heterogeneity in the methodologies used. The aim of this
complementary review is to report on existing guidance in
HE and to critically assess guideline compliance in the
radiotherapy literature.
Material and Methods
A systematic literature review of cost computation studies
in external photon beam radiation therapy (EBRT) from
1981-2015 was recently conducted by us. Building on this
earlier work, existing HE guidelines have been reviewed
and a list of relevant items for cost estimations has been
compiled. The guidelines searched were ISPOR’s Good
Practices For Outcome Research guidelines, HE evaluation
quality appraisal instruments and National guidelines
(EUnetHTA). A standardised framework focusing on
recommendations on cost assessment was designed with
the help of these guidelines. Fifty-two HE studies meeting
criteria established in our earlier literature review were
studied in-depth: cost assessment methods, descriptions
of methodologies (e.g. sample size, time horizon, or
discounting clearly mentioned), and relevant statistical
analyses performed (e.g. selection bias treated,
sensitivity analyses done) were all critically appraised
within the framework.
Results
Guidance on HE analyses is often provided in the form of
a checklist of items to be addressed. Direction on the cost
type to estimate, the analysis to conduct, and methods for
tackling uncertainty of data are outlined, e.g. ‘’identify
relevant cost for each alternative and value the cost
appropriately’’. Evaluation of the 52 studies against
published HE recommendations revealed shortcomings in
the cost assessment methodologies, the implications of
that choice, and the calculation methods used.
Among selected studies, heterogeneity was observed in
the quantity and quality of the information disclosed.
While documentation of cost items and sample size was
found in 67% of the 52 articles, and the reference year of
cost data was present in 85%, only 37% of the articles
specified data sources used by the authors, 35% stated
their discounting methods and just 8% mentioned the
study’s time horizon. Descriptive statistics analyses were
present in 35% of the studies and uncertainty treatment in
48%.
Conclusion
Existing guidance on formulating the cost part of HE
evaluation studies establishes an outline framework while
giving researchers a high degree of freedom. The limited
number of studies investigating the cost of EBRT do not
systematically follow these published HE guidance leaving