Comparison of Methods for Measuring Radiotherapy Utilisation

AIMS

Evidence-based estimates of appropriate rates of radiotherapy utilisation are usually stated as the proportion of cancer patients who should receive radiotherapy at least once in their lifetime. However, the prolonged follow-up required to measure the lifetime radiotherapy rate limits its value in monitoring access to radiotherapy in routine practice. The objectives of this study were to evaluate shorter-term methods for measuring radiotherapy utilisation and to determine how well they predict the lifetime radiotherapy rate.

MATERIALS AND METHODS

The Ontario Cancer Registry provided records of all cases of cancer diagnosed in Ontario between 1984 and 2015. Records of all radiotherapy delivered by Ontario cancer centres were linked to individual cases in the Ontario Cancer Registry. Patients were followed forward for 20 years to determine the relationship between short-term and long-term rates of use of radiotherapy. Radiotherapy utilisation was also estimated by comparing total radiotherapy workload with cancer incidence; these measures were compared with observed long-term radiotherapy rates.

RESULTS

The rate of use of radiotherapy within 1 year of diagnosis (RT_1y) was strongly predictive of the rate of use of radiotherapy after 20 years (RT_20y); for each annual cohort of cases between 1984 and 1995, RT_20y was approximately equal to 1.3 × RT_1y. The number of cases treated for the first time with radiotherapy in a specified period, divided by the number of new cases diagnosed in the same period, was about equal to the proportion of cases treated with radiotherapy within 20 years of diagnosis (RT_20y).

CONCLUSIONS

The lifetime rate of use of radiotherapy may be predicted quite accurately from the rate observed within 1 year of diagnosis, or from the ratio of new cases treated to cancer incidence in a specified period. Either of these measures may therefore be used to audit radiotherapy utilisation against the existing evidence-based targets.

Projections of hip arthroplasty in OECD countries up to 2050

OBJECTIVE

The study aims to estimate the future demand of hip arthroplasty for OECD countries and to compare the results with earlier studies.

DESIGN

Based on data availability and validity 20 countries out of the OECD sample have been selected for projection analysis. Using historic data (1995-2012) and multiple linear regression technics a projection model was designed by an iterative process considering different explanatory variables such as health care expenditure, age groups, and projection time frames.

RESULTS

The utilisation of hip implants in OECD countries continues to grow by a compound annual growth rate (CAGR) of 1.2%, leading to an increase from 1.8 million per year in 2015 to 2.8 (2.6-2.9) in the year 2050. The mean utilisation rate (incidence) of hip implants will increase from 184 (143-312) to 275 (174-457) per 100.000 total population in the same time. Australia, Ireland, Norway, Switzerland and other countries will face a significant increase of utilisation of hip implants between +95% and +120% from 2015 to 2050.

CONCLUSIONS

Hip arthroplasty continues to rise significantly over the next 35 years. Therefore, some countries will face an exponential use of hip arthroplasty of additional 100% or more and thus challenges for their health care budgets. Revision burden will increase disproportionately. Thus, health technology assessment (HTA) for medical devices, longevity and quality control will become more relevant.

Trends in computed tomography utilisation in the emergency department: A 5 year experience in an urban medical centre in northern Taiwan

BACKGROUND

Steady increase in computed tomography (CT) utilisation in the ED was observed in countries such as the USA, Canada, China and Korea; however, limited empirical data are available regarding Taiwan.

OBJECTIVE

The objective of the present study is to quantify and compare trends in CT utilisation in the ED over a 5 year period in a medical centre in Taiwan.

METHODS

Electronic chart review was performed in a medical centre with an annual ED census of 80 000 patients. Subjects >20 years of age who underwent CT scans during ED visits from 1 January 2005 to 31 December 2009 were identified.

RESULTS

Among the 333 673 adult ED visits, 43 635 received CT scans, with a utilisation rate of 131 per 1000. Within the 5 year span, patient volume increased by 7.7%, whereas CT utilisation increased by 42.7%. The rates of increase in patient volume and CT utilisation were 5.0% and 32.4% in non-trauma; 19.7% and 97.8% in trauma. CT scans were mostly performed on the head (47%), abdomen (36%), followed by chest (10%) and miscellaneous (7%). An increase of 168% in spinal CTs for trauma patients was observed. An increase in CT utilisation was found in all age groups with a proportionate increase with increasing age in both trauma and non-trauma.

CONCLUSION

ED CT utilisation has increased at a rate far exceeding the growth in ED patient volume. This may be attributed to the improved utility of CT in diagnosing serious pathology, more diagnostic indications for CT, ready availability and the necessity for diagnostic certainty in the ED.