The costs of radiosurgical treatment: Comparison between gamma knife and linear accelerator

Radiosurgical treatment can be carried out by means of a Gamma Knife or a L inear Accelerator. The Linear Accelerator may be either a single-purpose ap pliance, exclusively employed in radiosurgery, or an adapted appliance, whi ch is used primarily for fractioned radiotherapy, and only additionally for radiosurgical purposes. The first alternative will be referred to briefly as a "dedicated Linac", the latter as an "adapted Linac". Cost accounting data for these alternatives will be discussed under three m ain categories: investment costs, operating costs, and finally staffing cos ts. Costs are only considered to the extent that this is necessary to facil itate a comprehensive cost comparison. Factors for which the costs remain t he same or at least broadly the same will from the outset not be taken into consideration. These include, for instance, the costs of general or specia l administration, diagnosis, and image processing. The results and conclusi ons of this study therefore cannot be employed immediately in the evaluatio n of cost reimbursement schemes of the type carried out by agencies respons ible for social insurance. Here, appropriate complete cost analyses especia lly for this purpose are required. The final comprehensive cost comparison reveals that the adapted Linac is t he most favourable alternative with small annual quantities of patients. Wi th larger numbers of patients the Gamma Knife represents the most favourabl e From a cost accounting angle. The dedicated Linac accordingly does not ha ve a cost advantage for any of the examined numbers of patients. Clearly th e lowest treatment costs per patient can be achieved by employing a Gamma K nife and using it to capacity.