Introduction:Intracranial stereotactic radiosurgery (SRS) is a specialised radiotherapy technique that plays an essential role in achieving local control of brain metastases and therefore optimising quality of life for many cancer patients. It also confers a survival benefit in selected patients. Rural and regional Australians may face significant challenges in accessing this treatment, as it is predominantly delivered at metropolitan institutions. We sought to assess the cost-effectiveness of a brain SRS service implemented using local resources at a North Queensland regional hospital from a societal perspective.Methods:We prospectively collected treatment costs and clinical outcomes for a consecutive cohort of patients who received SRS for intracranial metastatic lesions at a regional cancer centre since the implementation of the brain SRS program in September 2022. We compared the healthcare and non-healthcare costs (e.g., travel and informal care) with the costs that would have otherwise been incurred if patients were referred to metropolitan centres in the state capital. Clinical outcomes incorporated overall survival, intracranial disease control rates, and incidence of radiation necrosis. Clinical outcome data of the metropolitan centres were derived from the published literature.Results:A total of 34 patients received treatment during the study period. Their median age was 65 years (range: 49–78 years). Around 47% received adjuvant SRS following surgical resection, and the remaining 53% were treated for intact brain metastases. The predominant primary malignancy was non-small cell lung cancer. The mean total cost per course of brain SRS at a regional hospital was AUD 6690, including AUD 5754 for healthcare and AUD 1682 for non-healthcare costs, across 34 patients recruited between September 2022 and August 2024. This was AUD 760 less than that of a course of treatment delivered at a metropolitan hospital. Median survival among the cohort was 15.7 months, and eight patients (24%) developed radionecrosis; these were comparable to published data reported by Australian urban and international institutions.Conclusions:The implementation of a brain SRS service at regional cancer centres utilising existing infrastructure and local expertise has the potential to offer cost-effective treatment to rural and regional cancer patients. This approach improves access for patients who might otherwise face logistics barriers and competing life priorities when seeking treatment in metropolitan centres.
引言：颅内立体定向放射外科（SRS）是一种专业放射治疗技术，在实现脑转移灶局部控制方面发挥关键作用，从而显著改善众多癌症患者的生活质量，并为特定患者群体带来生存获益。由于该治疗主要集中于大都市医疗机构，澳大利亚乡村及偏远地区患者在获取此项服务时面临显著障碍。本研究旨在从社会视角评估昆士兰北部地区医院利用本地资源开展脑SRS服务的成本效益。 方法：自2022年9月脑SRS项目启动以来，我们前瞻性收集了某区域性癌症中心连续收治的颅内转移灶SRS治疗患者的治疗成本与临床结局数据。通过对比分析实际发生的医疗与非医疗成本（如交通与非正式照护），与假设患者转诊至州首府大都市医疗中心可能产生的费用差异。临床结局指标包括总生存期、颅内疾病控制率及放射性坏死发生率，其中大都市医疗中心的临床结局数据来源于已发表文献。 结果：研究期间共34例患者接受治疗，中位年龄65岁（范围：49-78岁）。约47%患者接受手术切除后辅助SRS治疗，其余53%针对未切除脑转移灶进行治疗。主要原发恶性肿瘤为非小细胞肺癌。2022年9月至2024年8月期间，区域性医院单疗程脑SRS治疗平均总成本为6690澳元，其中医疗成本5754澳元，非医疗成本1682澳元，较大都市医院单疗程治疗成本降低760澳元。该队列患者中位生存期为15.7个月，8例患者（24%）发生放射性坏死，这些数据与澳大利亚城市机构及国际机构报道的公开数据具有可比性。 结论：区域性癌症中心利用现有基础设施和本地专业力量开展脑SRS服务，有望为乡村及偏远地区癌症患者提供具有成本效益的治疗方案。该模式能有效改善患者就医可及性，避免患者因前往大都市中心治疗可能面临的交通障碍与生活优先级冲突问题。
肿瘤(癌症)患者之家