S1431
Interdisciplinary - Health economics & health services research
ESTRO 2026
For HM with DIBH, reimbursement decreased to € 3,764, and for UH to € 1,255. Relative linear accelerator occupancy decrease d to approximately 60% for HM and 20% for UH compared with CF. Personnel time per patient followed a similar reduction; however, fixed- cost components (simulation, planning, and dosimetry ) increased in relative weight: 18% (CF), 26% (HM), and 52% (UH). Thus, UH regimens centralize cost in preparatory stages that are not proportionally recognized in reimbursement. The resulting financial misalignment creates a structur al disincentive to adopting UH despite its demonstrate d clinical appropriateness and efficiency gains. Conclusion: TD- ABC analysis demonstrates that while HM and UH regi mens improve operational efficiency and reduce mach ine time, the current fraction- based reimbursement framework significantly reduces revenue and inadequately compensates fixed plannin g resources costs. This misalignment may hinder the a doption of clinically validated, cost- effective radiotherapy strategies for breast cancer. Principal limitations include the assumption of full res ource utilization, absence of workflow inefficiencies, a nd exclusion of process variability, which likely result i n conservative cost estimates. References: 1. Brunt AM, Haviland JS, Wheatley DA, et al. Hypofractio nated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year outcomes. Lancet. 2020;395(10237):1613-1626. 2. Haviland JS, Owen JR, Dewar JA, et al. The UK Standardisation of Breast Ra diotherapy (START) trials. Lancet. 2013;381(9860):1098-1107. 3. Kapadia SJ, Ben- Josef E, Liu J, et al. Time-driven activity- based costing for breast cancer radiotherapy. Pract Ra diat Oncol. 2022;12(3):e256-e266. Keywords: Breast Neoplasms, Radiotherapy, Health Care Costs
APN, PBM, dietetic and speech therapy interventions during head and neck radiotherapy is feasible and improves care coordination. Early, centralized scheduling by a specialized coordination cell represents a key organisational innovation that could be replicated across other tumour sites. Keywords: supportive care, coordination, head and neck Digital Poster 5170 Financial Impact of Ultra-Hypofractionated Breast Radiotherapy: A Time-Driven Activity-Based Costing (TD-ABC) Analysis Daniela Saraiva 1,2 , Pedro Meireles 1 , Armanda Monteiro 1 , Luís Porto Gomes 1 , Lígia Osório 1 1 Radiotherapy, ULS São João, Porto, Portugal. 2 University of Vigo, University of Vigo, Vigo, Spain Purpose/Objective: To assess the financial implications of adopting moder ately hypofractionated (HM) and ultra- hypofractionated (UH) radiotherapy regimens for brea st cancer within the current reimbursement model in Portugal. While HM and UH schedules demonstrate eq uivalent oncological outcomes to conventional fraction ation (CF), reimbursement defined by Ordinance 254/2 018 remains fraction- based, potentially creating financial disincentives to im plement more time-efficient and cost- effective treatment protocols. This study applies Time- Driven Activity-Based Costing (TD-ABC) to estimate real treatment delivery costs and to analyz e the alignment between resource utilization and reim bursement. Material/Methods: A TD- ABC framework was developed to map the complete r adiotherapy workflow, covering patient simulation, tre atment planning, dosimetry, verification, and treatmen t delivery. Resource consumption (personnel time stra tified by professional category, linear accelerator occupancy, and supporting processe s) was quantified for three fractionation schedules: CF (50 Gy/25 fractions), HM (40 Gy/15 fractions), and UH (26 Gy/5 fractions). Cost rates were derived from stand ard salary scales and equipment amortization paramet ers. Reimbursement values were obtained from the na tional tariff schedule, differentiating between simple a nd complex procedures (e.g., requiring deep inspiratio n breath-hold, DIBH). Comparative analyses evaluated total cost com position, fixed versus variable cost proportion, and rei mbursement-per-course. Results: Reimbursement values for CF were € 6,273 (w/ DIBH).
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