Author: Xinyuan Chen, Geoffrey D. Hugo, Alex T. Price, Pamela Samson, Tianyu Zhao 👨🔬
Affiliation: University Hospitals Seidman Cancer Center, University of South Florida, Washington University School of Medicine, WashU Medicine 🌍
Purpose: This study evaluates the financial viability of on-table simulation (CBCTp) enabled Halcyon system in radiation therapy. By leveraging Time-Driven Activity-Based Costing (TDABC), the analysis assesses three utilization scenarios: (1) single Halcyon (no CT simulator), (2) Halcyon with CT simulator, and (3) Halcyon with a standard C-arm linac (TrueBeam) with no CT simulator.
Methods: The study collected data on patient population, machine costs, and operational expenses from clinics of various sizes in our healthcare system. TDABC was used to calculate the net revenue under varying treatment (15-30 mins on Halcyon, 20-60 mins on TrueBeam depending on treatment sites) and simulation times (30 mins on Halcyon, 1hr on CT simulator). A simulation framework modeled patient scheduling, treatment workflows, and revenue outcomes over a 10-year period, incorporating ±20% variation in treatment and simulation times for sensitivity analysis.
Results: A single Halcyon could efficiently handle up to two new-sim patients daily while maintaining positive net revenue. A 20% reduction in treatment time increased capacity to three new-sim patients. Adding a CT simulator improved capacity to three patients with consistent net , while adding a second standard linac enabled up to four new-sim patients. However, the latter scenario incurred additional costs, resulting in negative net revenue unless patient volumes exceeded two new-sim patients per day.
Conclusion: CBCTp on Halcyon offers a financially viable solution for integrating on-table simulation into radiation therapy workflows, particularly when standalone CT simulators are unavailable. Adding a CT simulator or a second treatment unit enhances patient capacity but requires higher patient volumes for cost-effectiveness. These findings underscore the importance of aligning technology utilization with patient demand and clinic workflows to achieve sustainable financial performance in radiation oncology.