A COST MINIMISATION EXERCISE- CHANGING THE PRACTICE OF INPATIENT HDR INTRACAVITARY BRACHYTHERAPY FOR CERVICAL CANCER TO OUTPATIENT PROCEDURE
Abstract
Background- The cost of HDR intracavitary brachytherapy contributes to almost 50 of the
cost of cervical cancer treatment at our Institution. This exercise was undertaken to reduce the cost
without compromising on the treatment. The introduction of cervical sleeve was aimed at executing
the HDR intracavitary brachytherapy application as outpatient.Objectives- To assess the feasibility of
converting the procedure of HDR intracavitary brachytherapy for carcinoma cervix from an inpatient to
an outpatient procedure with the aid of a cervical sleeve and to execute a comparative cost effective
analysis of the Intracavitary Brachytherapy treatments, inpatient versus outpatient
procedure.Methods- 1 study patient and 3 control patients were chosen. The study patient underwent
cervical sleeve placement followed by HDR intracavitary applicator placement under anaesthesia
during the first fraction while the second and third fractions were executed as outpatient under mild
sedation. The 3 control patients underwent all three applications as inpatient under anaesthesia. The
cost of treatment to study and control patients was documented and the effectiveness was analysed
by comparing the dose to point A and dose to organs at risk.Results- The medical cost was reduced
by 30 percent when procedure was done as outpatient (Rs. 7,395). The non-medical cost incurred by
study patient was half that of the control patients. Study patient saved a total sum of Rs. 10,000 by
undergoing the second and third fractions of HDR intracavitary brachytherapy applicator placement
as outpatient. There was no compromise on the tumor dose (dose to point A) and the dose to organs
at risk was within the tolerance levels.Conclusion- It is feasible to execute HDR intracavitary
brachytherapy applicator placement under mild sedation as outpatient with the aid of a cervical
sleeve. The total cost of the brachytherapy treatment for cervical cancer can be reduced by 26
percent. The cost effectiveness of outpatient versus inpatient procedure was similar.
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