Testing criterion-based benchmarking for the appropriate use of radiotherapy

Planning for radiotherapy (RT) services requires information on the proportion of patients who should be given radiotherapy. Criterion-Based Benchmark (CBB) has been proposed in Canada to estimate the proportion of cancer patients who should be treated with radiotherapy. The aim of this study was to assess CBB in a health system outside of Canada.

Radiotherapy data for all new cases of cancer in New South Wales (NSW), and the Australian Capital Territory (ACT) Australia in 2004-06 and were linked to Central Cancer Registry records. Road distances between patient residence and the nearest RT centre were calculated. Local Government Areas (LGAs) with public radiotherapy departments were selected as CBB LGAs if they met the following criteria: 1. Patients make no direct payment for radiotherapy. 2. All RT is provided by site-specialised radiation oncologists in multi-disciplinary centres. 3. Radiation oncologists receive salary for their service. 4. More than 75% of patients live within 30 km from the nearest RT, and 5. Patients' waiting times were <4 weeks.

25,383 (26%) out of 98,000 eligible patients in NSW and ACT received radiotherapy in the study period as part of their initial treatment. An average of 31% of patients in the CBB LGAs received radiotherapy compared to an average of 26% in all LGAs during the study period.

NSW-ACT RT utilisation for selected tumour sites was 7-16% higher in the CBB LGAs than in all LGAs, but was still 30-65% below the estimated optimal radiotherapy utilisation rates and differed significantly from Canadian CBBs. CBB is based on the assumption that there is perfect service delivery in some parts of the health service that can be used to benchmark the whole service. It may be applicable in well-resourced publicly-funded services in Canada, but the CBB approach may not be reproducible in other jurisdictions.