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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 10
Original paper

Cost in perspective: direct assessment of American market acceptability of Co-60 in gynecologic high-dose-rate brachytherapy and contrast with experience abroad

Raymond B. Mailhot Vega, David Barbee, Wesley Talcott, Tamara Duckworth, Bhartesh A. Shah, Omar F. Ishaq, Christina Small, Anamaria R. Yeung, Carmen A. Perez, Peter B. Schiff, Ophira Ginsburg, William Small Jr, May Abdel-Wahab, Gustavo Sarria Bardales, Matthew Harkenrider

J Contemp Brachytherapy 2018; 10, 6: 503–509
Online publish date: 2018/11/27
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While Ir-192 remains the mainstay isotope for gynecologic high-dose-rate (HDR) brachytherapy in the U.S., Co-60 is used abroad. Co-60 has a longer half-life than Ir-192, which may lead to long-term cost savings; however, its higher energy requires greater shielding. This study analyzes Co-60 acceptability based on a one-time expense of additional shielding and reports the financial experience of Co-60 in Peru’s National Cancer Institute, which uses both isotopes.

Material and methods
A nationwide survey was undertaken assessing physician knowledge of Co-60 and willingness-to-pay (WTP) for additional shielding, assuming a source more cost-effective than Ir-192 was available. With 440 respondents, 280 clinicians were decision-makers and provided WTPs, with results previously reported. After completing a shielding report, we estimated costs for shielding expansion, noting acceptability to decision makers’ WTP. Using activity-based costing, we note the Peruvian fiscal experience.

Shielding estimates ranged from $173,000 to $418,000. The percentage of respondents accepting high-density modular or lead shielding (for union and non-union settings) were 17.5%, 11.4%, 3.9%, and 3.2%, respectively. Shielding acceptance was associated with greater number of radiation oncologists in a respondent’s department but not time in practice or the American Brachytherapy Society membership. Peru’s experience noted cost savings with Co-60 of $52,400 annually.

By comparing the cost of additional shielding for a sample institution’s HDR suite with radiation oncologists’ WTP, this multi-institutional collaboration noted < 20% of clinicians would accept additional shielding. Despite low acceptability in the US, Co-60 demonstrates cost-favorability in Peru and may similarly in other locations.


brachytherapy, cobalt-60, costs and cost analysis, economics, decision-making, gynecologic tumor, HDR, survey

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