Improved management of radiotherapy departments through accurate cost data

Background and purpose: Escalating health care expenses urge governments to wards cost containment. More accurate data on the precise costs of health c are interventions are needed. We performed an aggregate cost calculation of radiation therapy departments and treatments and discussed the different c ost components. Materials and methods: The costs of a radiotherapy department were estimate d, based on accreditation norms for radiotherapy departments set forth in t he Belgian legislation. Results: The major cost components of radiotherapy are the cost of building s and facilities, equipment, medical and non-medical staff, materials and o verhead. They respectively represent around 3, 30, 50, 4 and 13% of the tot al costs, irrespective of the department size. The average cost per patient lowers with increasing department size and optimal utilization of resource s. Radiotherapy treatment costs vary in a stepwise fashion: minor variation s of patient load do not affect the cost picture significantly due to a sma ll impact of variable costs. With larger increases in patient load however, additional equipment and/or staff will become necessary, resulting in addi tional semi-fixed costs and an important increase in costs. A sensitivity a nalysis of these two major cost inputs shows that a decrease in total costs of 12-13% can be obtained by assuming a 20% less than full time availabili ty of personnel; that due to evolving seniority levels, the annual increase in wage costs is estimated to be more than 1%; that by changing the clinic al life-time of buildings and equipment with unchanged interest rate, a 5% reduction of total costs and cost per patient can be calculated. More sophi sticated equipment will not have a very large impact on the cost (+/-4000 B EF/patient). provided that the additional equipment is adapted to the size of the department. That the recommendations we used, based on the Belgian l egislation, are not outrageous is shown by replacing them by the USA Blue b ook recommendations. Depending on the department size, costs in our model w ould then increase with 14-36%. Conclusion: We showed that cost information can be used to analyze the prec ise financial consequences of changes in routine clinical practice in radio therapy. Comparing the cost data with the prevailing reimbursement may reve al inconsistencies and stimulate to develop improved financing systems. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.