Gynecology OncologyIncome generated by women treated with magnetic resonance imaging-based brachytherapy: A simulation study evaluating the macroeconomic benefits of implementing a high-end technology in a public sector healthcare setting
Introduction
MRI-based image-guided brachytherapy (MR-IGBT) in cervical cancers may result in an improvement in locoregional control [1], [2], [3], [4], [5], [6], [7], and reduction in late toxicities [3], [6], [7]. The cost of acquisition of MRI machines as well as MRI compatible applicators is a major impediment to wider adoption of MR-IGBT in developing nations (8) Unfortunately, patients in these settings often present with advanced disease, [9], [10] and may derive the greatest benefit from the dose escalation that MR-IGBT allows (7).
Although capital expenditure that is required for wider use of MR-IGBT in our setting is a concern, improved outcomes and its impact on the financial gain for the country needs to be evaluated. It can be assumed that women who are cured can potentially return to their previous occupation, especially in affluent economies. However, as only 35% of the women in India are engaged in activities that generate a quantifiable wage, the extent of this contribution not clear.
Our institute is one of the largest tertiary cancer care center in India and facilities as well as expertise for both basic X-ray-based and image-based brachytherapy (CT and MRI) are available. Although most manpower resources for practicing MR-IGBT is already available, lack of availability of a dedicated MRI in the department as well as an adequate number of MR-IGBT applicators limits routine implementation of MR-IGBT in our institute. Being a publicly funded institute, the capital intensive nature of acquisition and operation of these devices prompted this study. The objective of the present study was to simulate the income generated by women treated at our institute, if all of them were treated with MR-IGBT instead of conventional radiograph–based brachytherapy (CR-BT) over a period of 5 years. In addition, we wanted to see how this income generated compared with the expenditure that would be required for implementation of MR-IGBT.
Section snippets
Settings and location
The study was carried out at Tata Memorial Hospital, an apex tertiary care institute in India. Outcomes of patients treated with conventional radiograph–based high-dose-rate brachytherapy (CR-BT) were obtained from the analyses published in the year 2013 (11), whereas outcome data for patients treated with MRI-based brachytherapy were obtained from the patients enrolled in the EMBRACE study (12).
Study perspective
The annual excess expenditure incurred toward transitioning to an exclusive MR-IGBT practice was
Outcome in treated patients
A total of 463 patients were available for analysis, of whom 94 underwent MR-IGBT, whereas rest underwent 2D conventionally planned HDR brachytherapy. The baseline clinical characteristics of these patients are compared in Table 2. The lower prevalence of nodal disease in patients in CR-BT group may be due to the use of ultrasound only for evaluation of nodal disease in this group of patients.
At a median followup of 57 months, 165 events were observed in 463 patients. The median disease-free
Conclusion
Using outcome data from patients treated in our institute, the current simulation study suggests that the clinical benefits of MR-IGBT may translate into significant gains in the GNI. However more precise and robust estimates can only be obtained from comparative outcome data from trials comparing MR-IGBT versus CR-BT. If such studies demonstrate a similar improvement in the clinical outcome, the results of this study should provide a strong economic rationale for improving access to this
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Point-A vs. volume-based brachytherapy for the treatment of cervix cancer: A meta-analysis
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