[THe cost of radiotherapy. Piedmontese experience]

An integrated task force of radiotherapists and administrators of the Piedmont region studied the estimated cost of radiotherapy (RT) to compare it with the figures in the 502/92 law modifying the financing of medical structures. This law changed the financing method from productive factors compensation to actually provided performances compensation.

The RT departments of the Turin and Novara university hospitals, those of Ivrea and Asti and that of the Pinna Pintor Clinic (Turin) participated in the study, with 4889 examinations in the period of interest. The study consisted of 6 steps: 1) defining a nomenclator; 2) making a list of standard resources; 3) calculating the actual resource consumption; 4) relating 2) to 3); 5) calculating cost and times; 6) defining quality standards. A technical and/or a central group(s) carried out all the steps. The nomenclator indicates 13 main activities (e.g., irradiation, telecobalt therapy, brachytherapy, hyperthermia), each of them featuring some subactivities (e.g., telecobalt therapy: flash, a fixed beam, two opposing beams). The following productive factor were considered: a) personnel; b) material; c) investments; d) the service cost; e) general costs. The personnel cost (the main cost) was calculated as: A) routine activity; B) activity for other units; C) congress activity; D) research. The times for individual performances were estimated according to professional roles (e.g., medical doctor, physicist, technician, nurse, administrative) for each subactivity.

The estimated RT costs were as follows (please note that all figures are expressed in US $, at a rate of 1$ = ItL 1700). Irradiation: 15 (cost/session +/- 3%); telecobalt therapy: 30-55; Linac (energy < > 10 Mev): 38-60; special techniques: 931-2,314; HDR brachytherapy: 878-1,515; hyperthermia: 285; simulation: 50-92; dosimetry: 52-286; examination, treatment planning, follow-up, etc.: 24-59; immobilization devices, photographs, etc.: 3-66. The quality criteria are related to the personnel; high energy equipment; treatment planning; 3D dosimetry.

Our study led the Italian Ministry of Health to revise the estimated cost of RT examinations in July, 1996. We will further enquire into the new figures.