Table 1.
Added cost of MRI-IGRT
| Conventional radiotherapy (39 fractions) | SBRT (5 Fractions) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| CT-IGRT | MR-IGRT | CT-IGRT | MR-IGRT | ||||||||
| Category | Item | Subgroup | Cost (Range) | Quantity | 15 year cost | Quantity | 15 year cost | Quantity | 15 year Cost | Quantity | 15 year Cost |
| Installation costs | Unit | CT-IGRT: $2,965,000 ($2,326,000–3,604,000)21,22,23 MR-IGRT: $9M ($6–12M)23 |
x1 | $2,965,000 | $9,000,000 ($6–12M)x 1 | $9,000,000 | $2,965,000 x 1 | $2,965,000 | $9,000,000 x 1 | $9,000,000 | |
| Renovation | CT-IGRT: N/A MR-IGRT: $2M ($1 M-3M)24 |
N/A | N/A | x 1 | $2,000,000 | N/A | N/A | x1 | $2,000,000 | ||
| Maintenance costs | Annual service contract (first 2 years included) | CT-IGRT: 10% list price21 MR-IGRT: $550K ($300–800K)23,24 |
x13yr | $3,854,500 | x13yr | $7,150,000 | x13 yr | $3,854,500 | x13yr | $7,150,000 | |
| Personnel time/Costs | Consultation | Physician | $233/hr ($320 K-577K/yr)a | 1 hr x Pts (2,308) | $537,764 | 1 hr x Pts (1,463) | $340,879 | 1 hr x Pts (18,000) | $4,194,000 | 1 hr x Pts (8,571) | $1,997,043 |
| Nurse | $42/hr ($57 K-102K/yr)a | 1 hr x Pts (2,308) | $96,936 | 1 hr x Pts (1,463) | $61,446 | 1 hr x Pts (18,000) | $756,000 | 1 hr x Pts (8,571) | $359,982 | ||
| Receptionist | $15/hr ($22 K-37K/yr)a | 1 hr x Pts (2,308) | $34,620 | 1 hr x Pts (1,463) | $21,945 | 1 hr x Pts (18,000) | $270,000 | 1 hr x Pts (8,571) | $128,565 | ||
| Simulation | Therapist | $47/hr ($55 K-126K/yr)a | 0.5 hr x Pts (2,308) | $54,238 | 1.5 hr x Pts (1,463) | $103,142 | 0.5 hr x Pts (18,000) | $423,000 | 1.5 hr x Pts (8,571) | $604,256 | |
| Receptionist | $15/hr ($22 K-37K/yr)a | 0.5 hr x Pts (2,308) | $17,310 | 1.5 hr x Pts (1,463) | $32,918 | 0.5 hr x Pts (18,000) | $135,000 | 1.5 hr x Pts (8,571) | $192,848 | ||
| Planning | Physician | $233/hr ($320 K-577K/yr)a | 1 hr x Pts (2,308) | $537,764 | 1 hr x Pts (1,463) | $340,879 | 1 hr x Pts (18,000) | $4,194,000 | 1 hr x Pts (8,571) | $1,997,043 | |
| Dosimetrist | $61/hr ($106 K-126K/yr)a | 4 hr x Pts (2,308) | $563,152 | 4 hr x Pts (1,463) | $356,972 | 4 hr x Pts (18,000) | $4,392,000 | 4 hr x Pts (8,571) | $2,091,324 | ||
| Physicist | $96/hr ($160–210 K/yr)a | 1 hr x Pts (2,308) | $221,568 | 1 hr x Pts (1,463) | $140,448 | 1 hr x Pts (18,000) | $1,728,000 | 1 hr x Pts (8,571) | $822,816 | ||
| Treatment | Therapist | $47/hr ($55 K-126K/yr)a | 0.33 hr x 39 x Pts (2,308) | $1,395,900 | 0.5 hr x 39 x Pts (1,463) | $1,341,075 | 0.33 hr x 5 x Pts (18,000) | $1,395,900 | 0.5 hr x 5 x Pts (8,571) | $1,007,140 | |
| Receptionist | $15/hr ($22 K-37K/yr)a | 0.33 hr x 39 x Pts (2,308) | $445,500 | 0.5 hr x 39 x Pts (1,463) | $428,003 | 0.33 hr x 5 x Pts (18,000) | $445,500 | 0.5 hr x 5 x Pts (8,571) | $321,428 | ||
| On-treatment visit | Physician | $233/hr ($320 K-577K/yr)a | 0.25 hr x 8 x Pts (2,308) | $1,075,528 | 0.25 hr x 8 x Pts (1,463) | $681,758 | 0.25 hr x 1 x Pts (18,000) | $1,048,500 | 0.25 hr x 1 x Pts (8,571) | $499,261 | |
| Nurse | $42/hr ($57 K-102K/yr)a | 0.25 hr x 8 x Pts (2,308) | $193,872 | 0.25 hr x 8 x Pts (1,463) | $122,892 | 0.25 hr x 1 x Pts (18,000) | $189,000 | 0.25 hr x 1 x Pts (8,571) | $89,996 | ||
| Receptionist | $15/hr ($22 K-37K/yr)a | 0.25 hr x 8 x Pts (2,308) | $69,240 | 0.25 hr x 8 x Pts (1,463) | $43,890 | 0.25 hr x 1 x Pts (18,000) | $67,500 | 0.25 hr x 1 x Pts (8,571) | $32,141 | ||
| Follow-up visit | Physician | $233/hr ($320 K-577K/yr)a | 0.5 hr x 24 x Pts (2,308) | $6,453,168 | 0.5 hr x 24 x Pts (1,463) | $4,090,548 | 0.5 hr x 24 x Pts (18,000) | $50,328,000 | 0.5 hr x 24 x Pts (8,571) | $23,964,516 | |
| Nurse | $42/hr ($57 K-102K/yr)a | 0.5 hr x 24 x Pts (2,308) | $1,163,232 | 0.5 hr x 24 x Pts (1,463) | $737,352 | 0.5 hr x 24 x Pts (18,000) | $9,072,000 | 0.5 hr x 24 x Pts (8,571) | $4,319,784 | ||
| Receptionist | $15/hr ($22 K-37K/yr)a | 0.5 hr x 24 x Pts (2,308) | $415,440 | 0.5 hr x 24 x Pts (1,463) | $263,340 | 0.5 hr x 24 x Pts (18,000) | $3,240,000 | 0.5 hr x 24 x Pts (8,571) | $1,542,780 | ||
| CT-specific costs | Fiducial marker placement (CPT 55876) | $145.96 | _ | _ | _ | _ | 1 x Pts (18,000) | $2,627,280 | _ | _ | |
| Transrectal ultrasound guidance (CPT 76872) | $130.46 | _ | _ | _ | _ | 1 x Pts (18,000) | $2,348,280 | _ | _ | ||
| Prophylactic Ciprofloxacin 500 mg | $0.10 | _ | _ | _ | _ | 1 x Pts (18,000) | $1,800 | _ | _ | ||
| Hospitalization related to fiducial marker | _ | _ | _ | _ | 0.015 x Pts (18,000) | $2,755,080 | _ | _ | |||
| MRI-specific costs | Ancillary MR-equipment (O2 cart, etc) | $12,725 ($4,450–21,000) | _ | _ | x1 | $12,725 | _ | _ | x1 | $12,725 | |
| MR-Immobilization equipment | $26,000 ($0–52,000) | _ | _ | x1 | $26,000 | _ | _ | x1 | $26,000 | ||
| MR-physics equipment | $260,715 ($234,430–287,000) | _ | _ | x1 | $260,715 | _ | _ | x1 | $260,715 | ||
| Total | $20,094,732 | $27,556,925 | $96,430,340 | $58,420,361 | |||||||
| Cost per patient | 2,308 pts | $8,707 | 1,463 pts | $18,836 | 18,000 pts | $5,357 | 8,571 pts | $6,816 | |||
| Added cost of MR-IGRT | $10,129 | $1,459 | |||||||||
CT-IGRT, CT-guided radiotherapy; Hr, hour; K, thousand; M, million; MR, magnetic resonance;MRI-IGRT, MRI-guided radiotherapy; N/A, not applicable; Pts, patients;SBRT, stereotactic body radiotherapy; Txs, treatments; yr, year.
a
Hourly wages were calculated based on 40 h work weeks and 48 work weeks in a year.