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Radiotherapy utilisation in lung cancer in New Zealand: disparities with optimal rates explained
Graham Stevens1, Wendy Stevens, Sudha Purchuri
1Department of Oncology, Auckland Hospital, Park Rd, Grafton, Auckland, New Zealand. gstevens@adhb.govt.nz
Background And Purpose:
The intervention rate (IR) of radiotherapy (RT) is important for health service planning. As actual IRs are commonly lower than those predicted by models, we sought to determine the reasons for this discrepancy, using lung cancer in a mixed urban-rural region of New Zealand (NZ).
Methods:
The appropriate utilisation of RT was calculated as the sum of the actual utilisation 3 years post diagnosis (88% of cases deceased), the estimated utilisation of the 12% remaining alive, and the percentage of cases that may have benefited from RT but did not receive it.
Results:
The actual utilisation was estimated as 43% (range 40-48%). A further 8% of deceased cases may have benefitted from RT (but were not referred), giving an appropriate utilisation of 51%. An additional 3.5% that may have benefitted from RT declined management. The difference from modelled IRs was due to a combination of early mortality, refusal of treatment and assumed higher RT treatment rates for many clinical scenarios.
Conclusion:
The appropriate utilisation of RT was substantially lower than IRs derived from models. The assumptions from which these models were derived may result in over-estimates for resource planning purposes.
