Radiotherapy: Optimal machine configurations
Radiation treatment is one of the fundamental tools available in cancer treatment and one of the three cornerstones of multidisciplinary cancer care, along with chemotherapy and surgery.
The NSW Audit Office conducted a Performance Audit of NSW radiotherapy services in 2009 and recommended that NSW Health assess economies of scale to assist in considering the most cost effective machine configuration and the impact on access to services. The CHSD was commissioned to undertake a targeted literature review to assist NSW Health to respond to this issue.
There is limited academic literature relating to optimal machine configurations for radiotherapy services. The search strategy found the most useful literature focused on related aspects of utilisation.
NSW Health should be able to monitor developments in radiotherapy, particularly if they impact upon costs, machine capacity, workload and throughput considerations, workforce availability and geographic access. The search strategy was therefore focused particularly to look for references to economies of scale.
Determining the optimal machine configuration for centres must balance many competing factors and the quality of clinical outcomes is one of the most useful criteria on which to base judgements. There are diverse issues that impact upon radiotherapy services planning, and many are outside the scope of this literature review. Because of the scale and scope of the project, it did not address in detail the various models used to estimate the number of linear accelerators required for given populations and treatment rates.
The literature review and recommendations are relevant to NSW locations funded under the Commonwealth Government ‘Health and Hospital Fund Regional Cancer Centre Initiative’ announced in April 2010. This included the funding of two bunker, single machine units in Tamworth and Nowra and a two linear accelerator unit in Gosford. A second linear accelerator has been funded for both Lismore and Port Macquarie and a third linear accelerator for Wollongong.
Multiple factors will influence decision-making for this service planning issue. This literature review provides another ingredient for the population planning ‘melting pot’.
The literature review pointed out how the literature will need to be supplemented by new and emerging evidence, advances in best practice, the advice of clinical and technical experts, patient preferences and how decisions always have to be taken in the context of available public funds.
Thompson C, Fildes D, Grootemaat P and Gordon R (2011) Optimal Machine Configurations in Radiotherapy: Findings of a Targeted Literature Review. Centre for Health Service Development, University of Wollongong.
Photo by Michael Anderson