Unlocking economic gains: the impact of image-guided brachytherapy on cervical cancer treatment in Thailand

Objective This study aims to bridge the existing gap in knowledge by assessing the financial impact of image-guided brachytherapy (IGBT) in the management of cervical cancer in Thailand. Methods A web-based questionnaire was developed in 2019 to collect data from 14 radiotherapy centers across all regions of Thailand. The survey gathered information on the use of brachytherapy for cervical cancer treatment, encompassing both conventional brachytherapy (point-based prescription) and IGBT (volume-based prescription). Data on infrastructure, workforce, and costs were also collected, and predictions for radiotherapy usage in cervical cancer were calculated. The actual image-guided brachytherapy utilization (A-IGBTU) rate was calculated by dividing the IGBT fractions by the total brachytherapy fractions and multiplying the result by 100. The Radiotherapy Resources and Cost Calculator (RRCC; version 21.0) was used to assess shortages, while the economic model was based on clinical outcomes and toxicity models. Results Our survey revealed that 18,024 new patients were treated with radiotherapy, including 2,950 patients with gynecological cancers. Among these, cervical cancer accounted for 72% of the cases. The actual utilization rate of IGBT for cervical cancer was 33%. The RRCC (version 21.0) highlighted workforce shortages for radiation oncologists (ROs), medical physicists (MPs), and radiation technologists (RTTs) at 42, 63, and 61%, respectively. In the clinical outcome model, IGBT generated a total income of USD1,492,563. In the toxicity model, IGBT reduced the costs associated with treating grade-3 and grade-4 toxicities by at least 50%. Conclusion The actual utilization rate of IGBT for treating cervical cancer patients was 33%. The RRCC (version 21.0) highlighted workforce shortages across all roles. In our analysis, IGBT generated higher total income and significantly reduced the costs associated with treating severe toxicities.