J. X. Leng1, M. Gisiri2, P. Chaurasia3, P. Allin3, N. Masalu3, A. Saxton4, B. Li5, N. Chao4, J. P. Chino1, B. Likonda3, and K. Schroeder4; 1Department of Radiation Oncology, Duke University Medical Center, Durham, NC, 2Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of, 3Bugando Medical Centre, Mwanza, Tanzania, United Republic of, 4Duke University Medical Center, Durham, NC, 5Rayos Contra Cancer, Seattle, WA
Purpose/Objective(s): Cervical cancer is the most diagnosed cancer in Tanzania, a lower-middle income country (LMIC) that as a group bears nearly 90% of deaths from cervical cancer globally. Radiotherapy, including brachytherapy (BT), is the global-standard-of-care for locally advanced cervical cancer. Development in these settings is often limited by a lack of economic investment. To help inform these efforts, we aimed to characterize the costs associated with brachytherapy at Bugando Medical Centre (BMC), one of two public radiotherapy facilities for a country of 60 million and the only one in northern Tanzania. Materials/
Methods: Time-drive activity-based costing (TDABC) is a methodology used to evaluate costs in healthcare delivery using a bottom-up approach. Process maps for each component of BT were developed through two onsite visits. Salary and equipment cost data were obtained from administrative, physician, and physics staff. Amounts recorded in Tanzanian shillings (TZS) were converted to USD. This was used to calculate the capacity cost rate (CCR) for each resource, which was multiplied by process times in each step of the BT workflow to calculate total costs of treatment. Results: Three-fraction high dose rate (HDR)-BT using tandem-and-ring under anesthesia using one Cobalt-60 afterloader followed external beam radiotherapy for patients with locally advanced cervical cancer at BMC. There is a yearly contract for the HDR afterloader which accounted for source exchanges without additional costs. The process maps detailed steps from physician consultation, pre-op evaluation, BT procedure, C-arm imaging, 2D treatment planning, treatment delivery, applicator removal, and post-op recovery. The personnel CCR was $0.35/min for radiation oncologists, $0.12/min for anesthesia, $0.10/min for nurses, $0.23/min for medical physicists and $0.14/min for radiation therapists. The equipment CCR was $0.99/min for the HDR afterloader and $0.24/min for the mobile C-arm. The cost for a 3-fraction course of HDR-BT was $158.8. The costs of additional fractions of brachytherapy were modeled and calculated at $48.9 per additional fraction. Pre-op evaluation accounted for 11.9% of this cost, BT procedure 21.2%, treatment planning 8.4%, treatment delivery 53.4%, and post-op recover 5.1%. BT is a covered service under Tanzania’s National Health Insurance Plan, however a minority of patients (13%) treated in the department were insured. Conclusion: To our knowledge, this is the first study on radiotherapy costs in Tanzania. Limited data exist in LMICs on costs and cost-effectiveness for radiotherapy. These results provide a detailed understanding of the costs associated with brachytherapy delivery in this low-resource setting. BT machine time remain the most expensive resource in the department. Overall, BT services provide significant returns on investment at $158.8 per 3-fraction course. Future studies are ongoing to examine the clinical and economic impact of radiotherapy in Tanzania.
