Towards Quantifying the Impact of Hypofractionation vs. Standard Radiotherapy Treatment Regimens for Cancer on Costs Workflow and the Environment
Author(s)
Tonia T. Momoh, MA1, Joe Hilton, PhD1, Alice Copson, MSc1, David French, PhD1, Robert Chuter, PhD2, Katherine Payne, MSc, PhD1.
1The University of Manchester, Manchester, United Kingdom, 2The Christie NHS Foundation Trust, Manchester, United Kingdom.
1The University of Manchester, Manchester, United Kingdom, 2The Christie NHS Foundation Trust, Manchester, United Kingdom.
OBJECTIVES: to conceptualise and computationally implement a decision-analytic model to estimate the impact of delivering hypofractionation (shorter course; 5 days) versus standard radiotherapy (15/20 days) for the treatment of cancer (breast and prostate) on hospital costs, workflow and environmental impact in a hospital setting in the United Kingdom (UK).
METHODS: A six-step process was used to conceptualise and build a decision-analytic model:
Step one used semi-structured interviews with four experts (two oncologists; radiographer; physicist) to produce pathways of care for hypofractionation and standard radiotherapy.
Step two involved a model-conceptualisation process to select the relevant model type.
Step three used a rapid review of published decision-analytic models representing the workflow for different radiotherapy regimens.
Step four conducted a rapid review to identify published examples of estimating the impact of radiotherapy regimens on healthcare costs and the environment. The two rapid reviews combined Boolean logic and bidirectional citation searching (between 2000-2025) of defined databases (PubMed, MEDLINE, Google Scholar).
Step five collated expert opinion using one-to-one interviews to confirm the model structure and associated healthcare resources.
Step six involved coding a discrete event simulation model (DES) using the R open-source programming language.
RESULTS: The reviews identified 24 published studies. Nine studies used a DES to represent workflows. Seven studies compared the environmental impact of hypofractionation versus standard treatment. Eight studies estimated healthcare costs across different fractionation schedules. Two pathways of care representing radiotherapy treatment workflows (breast and prostate cancer) were produced. Two DES models were produced (breast and prostate cancer) representing the workflow (including bottlenecks and waiting times) and associated healthcare resource use and carbon footprint for a patient population treated at a UK-hospital.
CONCLUSIONS: This study has produced two DES that will be used to quantify the impact of hypofractionation on hospital costs, workflow and the carbon footprint when compared with standard radiotherapy treatment regimens.
METHODS: A six-step process was used to conceptualise and build a decision-analytic model:
Step one used semi-structured interviews with four experts (two oncologists; radiographer; physicist) to produce pathways of care for hypofractionation and standard radiotherapy.
Step two involved a model-conceptualisation process to select the relevant model type.
Step three used a rapid review of published decision-analytic models representing the workflow for different radiotherapy regimens.
Step four conducted a rapid review to identify published examples of estimating the impact of radiotherapy regimens on healthcare costs and the environment. The two rapid reviews combined Boolean logic and bidirectional citation searching (between 2000-2025) of defined databases (PubMed, MEDLINE, Google Scholar).
Step five collated expert opinion using one-to-one interviews to confirm the model structure and associated healthcare resources.
Step six involved coding a discrete event simulation model (DES) using the R open-source programming language.
RESULTS: The reviews identified 24 published studies. Nine studies used a DES to represent workflows. Seven studies compared the environmental impact of hypofractionation versus standard treatment. Eight studies estimated healthcare costs across different fractionation schedules. Two pathways of care representing radiotherapy treatment workflows (breast and prostate cancer) were produced. Two DES models were produced (breast and prostate cancer) representing the workflow (including bottlenecks and waiting times) and associated healthcare resource use and carbon footprint for a patient population treated at a UK-hospital.
CONCLUSIONS: This study has produced two DES that will be used to quantify the impact of hypofractionation on hospital costs, workflow and the carbon footprint when compared with standard radiotherapy treatment regimens.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD111
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology