The HERO Project: Inspire Awareness, Strengthen Radiotherapy, Deliver Equitable Access

Half of all cancer patients in Europe should receive radiotherapy (RT) during the treatment of their disease. But there is a remaining gap in RT provision, leading to suboptimal access. Additionally, healthcare budgets are tight, and economic evaluations are key to support decision making. The HERO project (Health Economics in Radiation Oncology) is developing a knowledge base for health economic evaluation of RT at the European level. It aims to provide solid data to engage with decision makers; it empowers the RT community to advocate for better resource planning and ultimately better care for patients, closing the gap in RT access. The project assessed the availability of RT in Europe, in terms of equipment, staffing and guidelines. Then, it investigated the need for RT in Europe. Applying available EU data to the CCORE group (Collaboration for Cancer Outcomes Research and Evaluation) decision trees of evidence-based indications, the RT optimal utilization proportion, existing gap and growing needs have been calculated. Finally, knowing the cost of treatment is needed for budget planning and reimbursement settings, HERO developed a cost accounting model, applying a time-driven activity-based costing (TD-ABC) methodology. The model gives insight on the national cost of RT: per treatment, on average and for various tumor types and techniques, on the resources required based on national patterns of care. Regarding availability of human and capital resources, there are big discrepancies in Europe, with sixfold variations across European countries for some of the resources. Looking at the need, while on average 51% of all cancer patients should receive RT, we miss out 30% of these. The need is further expected to increase with an average of 16% by 2025. Lastly, the HERO costing model is accessible online. Preliminary results are available for a fictitious country (Europalia), whose RT scenario is based on standard European practices: to serve a hypothetical cancer patient cohort of 100,000, the model computes an annual RT budget of 173,192,960€, an average RT treatment cost of 3518€ and, for common cancer types, an average breast and prostate treatment cost of respectively 3785 and 6092€. Currently, the model is used in Belgium, to help defining resource recommendations, and other countries are setting up task forces for the implementation of the tool nationally. HERO allows to advocate for RT and negotiate with decision makers, who need data on availability, needs and costs, when planning RT resources within their country. In addition, knowledge of the RT cost will promote and further ease cost-effectiveness analyses as well as the development of value-based health care oncology programs. Overall, the HERO project creates a movement of awareness within the cancer community, encourages national RT data collection and supports the promotion of optimal access to care with the ultimate aim of better outcome for the cancer patient.