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Cost analysis of Gamma Knife stereotactic radiosurgery

Published online by Cambridge University Press:  01 October 2007

Alison Griffiths ,
Luke Marinovich ,
Michael B. Barton  and
Sarah J. Lord
Alison Griffiths
Affiliation:
The University of Sydney
Luke Marinovich
Affiliation:
The University of Sydney
Michael B. Barton
Affiliation:
University of New South Wales and Liverpool Hospital
Sarah J. Lord
Affiliation:
The University of Sydney
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Abstract

Objectives: Stereotactic radiosurgery (SRS) is used to treat intracranial lesions and vascular malformations as an addition or replacement to whole brain radiotherapy and microsurgery. SRS can be delivered by hardware and software appended to standard linear accelerators (Linacs) or by dedicated systems such as Gamma Knife, which has been proposed as a more accurate and user friendly technology. Internationally, dedicated systems have been funded, despite limitations in evidence. However, some countries including Australia have not recommended additional reimbursement for dedicated systems. This study compares the costs of Linac radiosurgery with Gamma Knife radiosurgery.

Methods: Due to limited evidence on comparative effects, the economic analysis was restricted to a cost evaluation. The base-case analysis assumed a modified Linac was used only to treat SRS patients. However, because a modified Linac could be used to treat other radiotherapy patients, a second analysis assumed spare time was used to meet other radiotherapy needs, and Linac capital costs were apportioned according to SRS use.

Results: The incremental cost of Gamma Knife versus a modified Linac was estimated as AU$209 per patient. This result is sensitive to variations in assumptions. A second analysis proportioning capital costs according to SRS use showed that Gamma Knife may cost up to AU$1673 more per patient.

Conclusions: Gamma Knife may be cost competitive only if demand for SRS services is high enough to fully use equipment working time. However, given low patient demand and competing radiotherapy needs, Gamma Knife appears more costly and further evidence of survival or quality of life advantages may be required to justify reimbursement.

Keywords

Stereotactic radiosurgeryGamma KnifeLinacCostEconomic
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 4 , October 2007 , pp. 488 - 494
Copyright
Copyright © Cambridge University Press 2007

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