UCLA Journal of Radiation Oncology SPRING 2024 - Flipbook - Page 33
UCLA RADIATION ONCOLOGY JOURNAL
consideration.15 However, these apparent expenditures are perhaps less impactful than initially
anticipated when one considers other cost savings and increased utility that can be associated with
MRgRT. For example, when compared with CTgRT delivery in time-driven activity-based costing
analyses, it was estimated that MRgRT was only incrementally more expensive for the delivery of
stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma14 and in absolute dollars,
just $1,497 (in 2021 United States Dollars) more expensive per course of SBRT for prostate cancer16
from thehealth system perspective. Furthermore, while the upfront device costs seem expensive on
the surface, the machine costs are amortized over time, and much of the long-term costs associated
with MRgRT actually derive from associated staffing and personnel needs.17, 18 Ultimately though, cost
associated with new technology is often ephemeral in nature, and there are multiple advantages of
MRgRT that may actually invite cost-savings and improve value, as will be discussed. Given the upfront
investment required to implement MRgRT programs, early acquisition and use of MRgRT remains
primarily in larger, well-resourced medical facilities, and widespread adoption may initially be limited
by the inability of smaller facilities to acquire the necessary equipment and infrastructure.19, 20, 21 At
the same time, MRgRT has also demonstrated its ability to successfully integrate into the workflows
of some varied US healthcare practice settings—ranging from large academic centers22 to community
practices23 to universal access healthcare systems such as the Veterans Health Administration.24 This
suggests that even the high upfront costs are surmountable in a number of practice environments.
Early economic analyses of MRgRT, which mainly examine prostate cancer and focus on cost from
the provider perspective, highlight a few important points regarding the economic implications of
this technology.15 As it currently stands and as noted above, MRgRT is associated with incrementally
increased costs compared with CTgRT. However, these studies identify multiple practicable ways by
Figure 1. Sensitivity analysis of various costs within the MRI-guided radiation therapy (MRgRT) and CT-guided radiation therapy (CTgRT)
processes for stereotactic body radiation therapy (SBRT) in localized unresectable hepatocellular carcinoma. Reproduced with permission
from: Parikh, NP, Lee PP, Raman SS, et al. Time-driven activity-based costing comparison of CT-guided versus MR-guided SBRT. JCO
Oncol Pract. 16:e1378–1385. https://ascopubs.org/doi/full/10.1200/JOP.19.00605. No changes were made to this figure from the original
publication.
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