Abstract
Purpose or Objective Cost-effectiveness analysis prior to technology implementation is important, but often not performed. The international MR-Linac Consortium works towards evidence-based introduction of the 1.5 Tesla magnetic resonance imaging radiotherapy linear accelerator (MR-Linac). This paper aims to explore the knowledge and opinions about cost-effectiveness studies for implementation of MR-guided
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radiotherapy (MRgRT). Materials and Methods In an online survey, members of the international MR-Linac Consortium were asked about their knowledge and use of cost- effectiveness analysis of 1.5T MRgRT in their institutions. Results A total of 102 completed survey responses were received from the international MR-Linac Consortium from May to September 2021. Among the respondents, the majority were based in Europe (65%), followed by North America (20%), Asia (11%), Oceana (4%), and Latin America (1%). Of all respondents, 75 (74%) respondents provided MRgRT at their institution, 20 (20%) were in the process of technology installation, 2 (2%) considered technology acquirement and 5 (5%) were unspecified. The majority of respondents (61%) only understood the purpose cost-effectiveness analysis, 27% had no knowledge about it and 12% indicated to fully understand it. Furthermore, 42% of all respondents indicated that the MR-Linac is being evaluated on cost-effectiveness at their institution, 39% did not know and 19% indicated that such an evaluation was not being performed. Of the 43 respondents evaluating cost-effectiveness, the majority (60%) lacked knowledge of the methodology being applied or used scenario analysis, threshold analysis and/or decision analytical modelling. 54% of all respondents perceived that demonstrating the cost-effectiveness is important for reimbursement, 28% do not know and 18% do not think so. The three most frequently mentioned reasons for not performing cost-effectiveness analysis were lack of human resources (22%), lack of external incentive (19%) or funding (19%). 98% of all participants expected patient benefits and 62% perceived economic benefits from the MR-Linac over standard treatment. While participants were optimistic towards technology benefits, also critical remarks were given regarding the actual added value in the radiation oncology field, including technological complexities and the substantial staffing and structural investments. Conclusion A substantial proportion of members of the MR-Linac Consortium has no or only limited knowledge about cost-effectiveness analysis. While most participants claimed that demonstrating cost-effectiveness is important for reimbursement, the majority had no knowledge on whether cost-effectiveness analysis was performed at their institutions or indicated that it was not being performed. As a result, the opportunity to steer research and development within the MR-Linac Consortium may not be optimally used. More and better understanding of cost-effectiveness is needed to improve the use and quality of such analyses and the consortium.
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