P. Mehta Jr1, W. Andre1, S. Stone2, B. Fronkier2, O. Aworunse3, and T. Dalton3; 1UroPartners Cancer Treatment Center, Glenview, IL, 2Argent Global Services, Oklahoma City, OK, 3Boston Scientific, Marlborough, MA
Purpose/Objective(s): The introduction of rectal spacers has improved patient care through minimizing rectal radiation exposure in prostate cancer treatment. Despite the clinical benefits of rectal spacers, an in-depth comparison of their direct and indirect costs—important for guiding cost-conscious clinical decision making—remains unexplored. This study provides results from a micro-costing analysis to compare the economic implications of using polyethylene glycol (PEG with iodine) hydrogel spacers versus non-animal stabilized hyaluronic acid (NASHA) spacers. By evaluating the comprehensive costs associated with each procedure and treatment planning, including materials, labor, and procedural time, this research seeks to provide valuable insights, provide detailed and accurate cost information. This analysis is pivotal for healthcare providers and policymakers in selecting the most economically viable rectal spacer, ultimately informing best practices in prostate cancer radiotherapy. Materials/Methods: A micro-costing study was conducted through assessing the workflow at a cancer treatment center for patients receiving a rectal spacer and prostate cancer radiotherapy. The study took place over a three-week period. The methods included observational time and motion studies and qualitative discussions with staff for data collection and workflow assessment. The workflow included staff activities related to patient consultation, scheduling, spacer implantation procedure, CT scan, MRI scan and treatment planning. All spacers included in the study were implanted transperineally, utilizing a transrectal ultrasound, with the patient under MAC sedation. Results: The PEG with iodine spacer preparation and implantation direct handling combined labor was 13.6 minutes, compared to 24.5 minutes for NASHA spacer, for an estimated labor cost of $125.61 for PEG with iodine spacer and $149.79 for NASHA spacer. A second MRI for NASHA spacer patients may be ordered when not otherwise needed for PEG with iodine spacer. The total combined labor cost for a secondary MRI scan was $162.38. The total pre-radiotherapy cost, including consumables, labor, and anesthesia, for PEG with iodine spacer was $1,427.33, compared to $1,538.93 for NASHA spacer without secondary MRI and $1,701.31 with MRI. Contouring time performed by a highly experienced radiation physicist was 3.9 minutes for PEG with iodine spacer compared to 5.7 minutes NASHA spacer. Conclusion: PEG with iodine spacer reduces labor for implantation compared to NASHA spacer, offering potential labor savings and improved practice efficiency. These results highlight the importance of evaluating post-spacer MRI burden and advocates for a comprehensive approach to cost estimation, suggesting further research into indirect costs and broader economic impact. This research emphasizes the need for a holistic assessment of rectal spacer technologies in guiding cost-efficient prostate cancer treatment strategies.
