Cost Analysis of a Hybrid Applicator Compared to Syed Template-Based Interstitial Brachytherapy for Gynecologic Malignancies

Purpose: Interstitial brachytherapy plays a crucial role in the treatment of many women with gynecologic malignancies. Traditionally, interstitial brachytherapy has been carried out with a Syed template, requiring hospitalization for the duration of brachytherapy. However, more recently, hybrid applicators have been developed which allow certain women to be treated on an outpatient basis. The purpose of this study is to compare the cost of these two treatment modalities in order to determine which methodology can optimize patient cost and overall healthcare expenditure.

Methodology: Current Procedural Terminology (CPT) codes were obtained for 9 women treated with Syed template-based interstitial brachytherapy and 3 women treated with a hybrid applicator at a National Cancer Institute-designated Comprehensive Cancer Center. All women were treated with 3 fractions of brachytherapy. Gross charges billed were obtained using the CPT codes. Descriptive statistics were utilized to compare the two treatment modalities. A t test was used to compare mean costs between the groups.

Results: The average cost of Syed template-based interstitial brachytherapy was $82,011 (range $73,679-93,205) with a standard deviation of $6,587.66. The average cost of hybrid applicator-based treatment was $71,273 (range $69,899-73,688) with a standard deviation of $1,713.07. The two-tailed p-value for the difference between mean costs was 0.0219. The difference in total cost of treatment was largely driven by operating room (OR) costs, which are required for Syed template placement but are not for hybrid applicator-based treatments. The mean OR cost for a Syed-template based treatment was $24,362 (range $15,063-33,739), representing 18.7-38.7% of a patient’s total brachytherapy treatment cost. Total physician service charges totaled an average of $13,543 (range $11,525-15,445) in the hybrid treatment group compared to $6,129 (range $3,693-8,735) in the Syed template-based group. The remaining costs represented hospital-based, non-physician services.

Conclusions: When able to be utilized, hybrid applicators appear to represent a less costly treatment modality for women with gynecologic malignancies and the overall healthcare system in comparison to a Syed template-based approach. Further study is warranted to determine if this remains true with a greater number of patients and when more than 3 treatments are required. Moreover, a study demonstrating the true cost effectiveness of hybrid applicators is necessary.

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