Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad

Raymond B. Mailhot Vega; David Barbee; Wesley Talcott; Tamara Duckworth; Bhartesh A. Shah; Omar F. Ishaq; Christina Small; Anamaria R. Yeung; Carmen A. Perez; Peter B. Schiff; Ophira Ginsburg; William Small Jr; May Abdel-Wahab; Gustavo Sarria Bardales; Matthew Harkenrider

doi:10.5114/jcb.2018.79928

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Original paper

Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad

Raymond B. Mailhot Vega

,

David Barbee

,

Wesley Talcott

,

Tamara Duckworth

,

Bhartesh A. Shah

,

Omar F. Ishaq

,

Christina Small

,

Anamaria R. Yeung

,

Carmen A. Perez

,

Peter B. Schiff

,

Ophira Ginsburg

,

William Small Jr

,

May Abdel-Wahab

,

Gustavo Sarria Bardales

,

Matthew Harkenrider

J Contemp Brachytherapy 2018; 10, 6: 503–509

DOI: https://doi.org/10.5114/jcb.2018.79928

Online publish date: 2018/11/27

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AMA

Mailhot Vega R, Barbee D, Talcott W, et al. Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad. Journal of Contemporary Brachytherapy. 2018;10(6):503-509. doi:10.5114/jcb.2018.79928.

APA

Mailhot Vega, R., Barbee, D., Talcott, W., Duckworth, T., Shah, B.,  & Ishaq, O. et al. (2018). Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad. Journal of Contemporary Brachytherapy, 10(6), 503-509. https://doi.org/10.5114/jcb.2018.79928

Chicago

Mailhot Vega, Raymond B., David Barbee, Wesley Talcott, Tamara Duckworth, Bhartesh A. Shah, Omar F. Ishaq,  and Christina Small et al. 2018. "Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad". Journal of Contemporary Brachytherapy 10 (6): 503-509. doi:10.5114/jcb.2018.79928.

Harvard

Mailhot Vega, R., Barbee, D., Talcott, W., Duckworth, T., Shah, B., Ishaq, O., Small, C., Yeung, A., Perez, C., Schiff, P., Ginsburg, O., Small Jr, W., Abdel-Wahab, M., Bardales, G.,  and Harkenrider, M. (2018). Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad. Journal of Contemporary Brachytherapy, 10(6), pp.503-509. https://doi.org/10.5114/jcb.2018.79928

MLA

Mailhot Vega, Raymond B. et al. "Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad." Journal of Contemporary Brachytherapy, vol. 10, no. 6, 2018, pp. 503-509. doi:10.5114/jcb.2018.79928.

Vancouver

Mailhot Vega R, Barbee D, Talcott W, Duckworth T, Shah B, Ishaq O et al. Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad. Journal of Contemporary Brachytherapy. 2018;10(6):503-509. doi:10.5114/jcb.2018.79928.

Purpose
While Ir-192 remains the mainstay isotope for gynecologic high-dose-rate (HDR) brachytherapy in the U.S., Co-60 is used abroad. Co-60 has a longer half-life than Ir-192, which may lead to long-term cost savings; however, its higher energy requires greater shielding. This study analyzes Co-60 acceptability based on a one-time expense of additional shielding and reports the financial experience of Co-60 in Peru’s National Cancer Institute, which uses both isotopes.

Material and methods
A nationwide survey was undertaken assessing physician knowledge of Co-60 and willingness-to-pay (WTP) for additional shielding, assuming a source more cost-effective than Ir-192 was available. With 440 respondents, 280 clinicians were decision-makers and provided WTPs, with results previously reported. After completing a shielding report, we estimated costs for shielding expansion, noting acceptability to decision makers’ WTP. Using activity-based costing, we note the Peruvian fiscal experience.

Results
Shielding estimates ranged from $173,000 to $418,000. The percentage of respondents accepting high-density modular or lead shielding (for union and non-union settings) were 17.5%, 11.4%, 3.9%, and 3.2%, respectively. Shielding acceptance was associated with greater number of radiation oncologists in a respondent’s department but not time in practice or the American Brachytherapy Society membership. Peru’s experience noted cost savings with Co-60 of $52,400 annually.

Conclusions
By comparing the cost of additional shielding for a sample institution’s HDR suite with radiation oncologists’ WTP, this multi-institutional collaboration noted < 20% of clinicians would accept additional shielding. Despite low acceptability in the US, Co-60 demonstrates cost-favorability in Peru and may similarly in other locations.

keywords:

Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad

Raymond B. Mailhot Vega , David Barbee , Wesley Talcott , Tamara Duckworth , Bhartesh A. Shah , Omar F. Ishaq , Christina Small , Anamaria R. Yeung , Carmen A. Perez , Peter B. Schiff , Ophira Ginsburg , William Small Jr , May Abdel-Wahab , Gustavo Sarria Bardales , Matthew Harkenrider

brachytherapy, cobalt-60, costs and cost analysis, economics, decision-making, gynecologic tumor, HDR, survey