Intensity-modulated radiotherapy (IMRT) - KCE

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Intensity-modulated radiotherapy (IMRT) - KCE

38 Intensity-modulated radiotherapy KCE reports 62

7 BUDGET IMPACT SCENARIOS

7.1 RATIONALE

The purpose of the present analysis is to offer Belgian policy makers an insight into the

possible impact the further diffusion of IMRT may hold on the overall size of public

funding, in particular annual budgets running within the current regulatory framework.

As such, the results of the analysis will apply from a Belgian public payer’s perspective at

short term. The analysis of clinical data will be rooted in available scientific findings.

Inevitably, institutional factors such as reimbursement tariffs will refer exclusively to the

Belgian context. Expected, but as yet unquantifiable budget impact drivers will be

identified. The main outcome of this analysis will be the design of an updatable

reference frame laying bare the principal operational elements and relationships

influencing the budgetary endpoint.

7.2 KEY ASSUMPTIONS

7.2.1 Baseline Scenario

Our base case scenario will start from the assumption no IMRT treatments are

performed within reimbursed health care. IMRT, however, cannot be considered a

newly introduced technology from the Belgian public payer’s perspective as IMRT

treatments have been reported from 2001 on (see Figure 1). Consequently, we will

have to correct for distortions in our baseline stemming from this observation (cf.

infra).

Furthermore, a new legal framework for public financing of radiotherapy departments

was introduced as of April 25 th 2005 104 basing departmental funding for investment and

operational costs on the annual number of treatment courses weighted by category

types that apply to external radiotherapy (categories 1-4, see appendix 6). This implies

the departmental funding is directly impacted by the IMRT delivery, which is reimbursed

under category 4. More details can be found in appendix 8. Prior to this regulation, RT

investment and operational costs were reimbursed dependent on the annual number of

treated patients without further distinction.

The current billing code scheme distinguishing between various categories of RT

(Article 18) came into effect from June 1 st 2001. As we dispose of observations on the

number of delivered billing code items on an annual base, we shall take 2002 (first full

year after the introduction of the new billing code scheme) as the first year of our

simulation and will include the following years up to 2006, the most recent year for

which we extrapolated cancer incidences (cf. infra).

Our intent is to apply the current regulatory framework (including the new financing

scheme for investment and operational costs at RT department level) to the period

2002-2006 and to assess which would be the feasible budget impact of IMRT

implementation going by various scenarios (differences of comparator scenarios and

baseline scenario). Our budgetary endpoint will be measured in euro (nominal values).

As we dispose of the complete number of annually delivered RT courses by category,

including the indication of the number of IMRT courses (subgroup of category 4

courses) from 2002 on, we are able to simulate the category-weighted RT departmental

financing as if the current regulation would have applied to the period between 2002

and 2006. Moreover, we will correct for historically reported IMRT courses to simulate

the absence of IMRT courses in our baseline scenario.

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