The Economic Consequences of Delay in Radiotherapy: An Example in Early Breast Cancer
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Waiting times for cancer radiotherapy have been a concern in Ontario for the past 20 years. A recent review of the clinical trials literature shows that waiting is associated with an increased risk of recurrence. Recurrence and the downstream effects thereof (metastatic disease, death) are expensive to treat. If waiting times can be reduced, the health care system could experience a reduced level of expenditure on recurrence. The magnitude and nature of such reduced expenditures is not known in the scientific literature. This study proposed and described a methodology for estimating the net benefit of reduced waiting for radiotherapy. A cost-benefit analysis was chosen, in which costs were measured as the value of resources required to increase the capacity of a cancer centre, and benefits were measured as the value of averted recurrence, metastatic disease and death due to waiting. The association between increased capacity and reduced waiting was explored in a computer simulation model. Benefits were calculated using a Markov chain model (a mathematical model that simulates patient movement between different health states based on underlying probabilities). Costs and benefits for various lengths of waiting were combined into a summary measure: the Incremental Net Present Value of increasing capacity in a cancer centre. A simplified population of postmenopausal (55 years and older) early breast cancer patients who receive adjuvant radiotherapy after breast-conserving surgery was used to illustrate this methodology. Accordingly, a hypothetical example in which a cancer centre treating these breast cancer patients only was presented to illustrate the methodology developed here. Markov modeling was used to compute averted treatment costs due to a decrease in waiting for this population. The costs of operating a cancer centre were calculated based on actual operations data from the Cancer Centre of Southeastern Ontario. This work provides a useful framework upon which subsequent investigations of this type can be built. Furthermore, this study modernizes the scientific literature regarding the medical care costs of local recurrence. It is our hope that the method proposed herein will be used in subsequent explorations of the issue of the economics of waiting.