Cost Recovery of Second Linear Accelerator in the 5th Health Region

Abstract

Cancer is currently a major global public-health problem. Radiation therapy is widely used to treat cancer patients. Ratchaburi Hospital is the only hospital in the 5th Health Region with a Radiation Oncology Center. Nowadays, the numbers of patients are increasing, resulting in longer waits for radiation treatment of > 6 weeks, exceeding the threshold limit. Some cases have had to be moved to other regions due to the availability of only one radiation machine in Ratchaburi Hospital. A second radiation set is considered to be needed, and a study is required to determine the payback period for the investment, to support decision-making by management in the 5th Health Region. This analytical research study aimed to examine the costs per service unit based on the usage of the radiation set, to determine an internal rate of return for the overall investment associated with radiation treatment at Ratchaburi Hospital, to determine a breakeven point, and the number of services of the second linear accelerator, and to investigate a payback period for the service unit of the second linear accelerator in the 5th Health Region. Data collection and analysis included a retrospective analysis of service providers and secondary data in fiscal years 2015 and 2016. The findings indicated that, after installing a 2D/3D radiation machine, the total amount of serviced patients was 2830; the machine was used 24,031 times. It was found that the number of serviced patients increased dramatically. In 2015, the number of patients increased by 188.26% (compared with 2014), and in 2016, the number of patients increased by 39.13% (compared with 2015). The total direct cost is the largest cost component, comprising cost ratios of investment:material:labor of 63.90:24.07:12.03, respectively, in 2015, and 60.33:23.12:16.55, respectively, in 2016. In 2015, the unit costs were 15,938.90 Baht per patient and 1854.70 Baht per visit, while in 2106, the unit costs were 12,135.06 Baht per patient and 1,454.25 Baht per visit. The rate of return on the total investment was calculated as 1.46%, and the break-even point was usage 12,970 times. In addition, this study showed that the breakeven points of 2D/3D, IMRT, and VMAT were 15,046, 15,707, and 13,974 patients, respectively. Compared with service provision 10,000 times per year, the payback periods for 2D/3D and IMRT were 1.4 years, and VMAT 1.3 years.