High dose rate versus low dose rate brachytherapy for squamous cell carcinoma of the cervix: an economic analysis

Brachytherapy is an established and important part of the management of invasive carcinoma of the cervix. Available evidence suggests that low dose rate (LDR) and high dose rate (HDR) are equivalent in terms of tumour control, adverse effects and survival. Proponents of outpatient HDR argue that it is less costly than LDR, but no economic evaluation has been published. We compared the costs of HDR and LDR (capital, operating, maintenance, source and operating costs) for Nucletron intracavitary equipment under alternative assumptions about the number of patients treated per year, the number of insertions per patient and discount rate. For example, for 3 HDR fractionations compared with 1 LDR fractionation, the LDR-3 (Nucletron) is the most cost-effective, practical machine for up to 40 patients per year. Although LDR-3 is more cost effective for a greater number of patients, HDR would be recommended for more than 40 patients a year for practical reasons. Similarly, for 5 HDR compared with 2 LDR fractionations, LDR-3 would be recommended for up to 20 patients per year and HDR for a greater number of patients. Recommendations for other HDR/LDR fractionations and annual number of patients seen can be derived from the model. This recommendation is based on no cost sharing with other sites. Cost sharing was beyond the scope of this analysis, though the principles are similar to the ones used. The model may be adapted to help equipment decision-making for a brachytherapy programme for an individual centre.