Time-Driven Activity-Based Costing of CT-Guided vs MR-Guided Prostate SBRT

Area of Science:

• Radiation Oncology
• Medical Physics
• Health Economics

Background:

• Stereotactic body radiation therapy (SBRT) is a standard for localized prostate cancer.
• Computed-tomography-guided radiation therapy (CTgRT) has been traditional, but MR-imaging-guided radiation therapy (MRgRT) offers advantages like real-time visualization and adaptive planning.
• Provider cost differences between MRgRT and CTgRT for prostate SBRT are not well-established.

Purpose of the Study:

• To determine the difference in provider costs for delivering prostate SBRT using MRgRT versus CTgRT.
• To utilize time-driven activity-based costing (TDABC) to quantify resource consumption.

Main Methods:

• Data collected from a single academic institution using both CTgRT and MRgRT for prostate SBRT.
• Process maps created via personnel interviews and treatment time measurements.
• Calculated personnel and equipment costs, aggregating total costs for both modalities.

Main Results:

• MRgRT delivery cost $1,497 more per 5-fraction course than CTgRT.
• Higher costs for MRgRT were driven by space/equipment ($1,542), partially offset by lower material costs.
• MRgRT treatment vault time per fraction was longer (31 min) compared to CTgRT (20 min).

Conclusions:

• This study provides an initial comparison of direct provider resource utilization for prostate SBRT delivered via MRgRT versus CTgRT.
• Further data from trials like the MIRAGE trial are needed to compare toxicities and survival outcomes.
• Cost differences will be contextualized by future efficacy and safety data.