A COST MINIMISATION EXERCISE- CHANGING THE PRACTICE OF INPATIENT HDR INTRACAVITARY BRACHYTHERAPY FOR CERVICAL CANCER TO OUTPATIENT PROCEDURE

Background- The cost of HDR intracavitary brachytherapy contributes to almost 50 of the cost of cervical cancer treatment at our Institution. This exercise was undertaken to reduce the cost without compromising on the treatment. The introduction of cervical sleeve was aimed at executing the HDR intracavitary brachytherapy application as outpatient.Objectives- To assess the feasibility of converting the procedure of HDR intracavitary brachytherapy for carcinoma cervix from an inpatient to an outpatient procedure with the aid of a cervical sleeve and to execute a comparative cost effective analysis of the Intracavitary Brachytherapy treatments, inpatient versus outpatient procedure.Methods- 1 study patient and 3 control patients were chosen. The study patient underwent cervical sleeve placement followed by HDR intracavitary applic ator placement under anaesthesia during the first fraction while the second and third fractions were executed as outpatient under mild sedation. The 3 control patients underwent all three applications as inpatient under anaesthesia. The cost of treatment to study and control patients was documented and the effectiveness was analysed by comparing the dose to point A and dose to organs at risk.Results- The medical cost was reduced by 30 percent when procedure was done as outpatient (Rs. 7,395). The non -medical cost incurred by study patient was half that of the control patients. Study patient saved a total sum of Rs. 10,000 by undergoing the second and third fractions of HDR intracavitary brachytherapy applicator placement as outpatient. There was no compromise on the tumor dose (dose to point A) and the dose to organs at risk was within the tolerance levels.Conclusion- It is feasble to execute HDR intracavitary brachytherapy applicator placement under mild sedation as outpatient with the aid of a cervical sleeve. The total cost of the brachytherapy treatment for cervical cancer can be reduced by 26 percent. The cost effectiveness of outpatient versus inpatient procedure was similar.