# Cost-Effectiveness Analysis of an Intracranial Stereotactic Radiotherapy Service for Brain Metastasis in a North Queensland Regional Cancer Centre

## TL;DR

This study shows that providing brain cancer treatment in regional hospitals is cost-effective and improves access for rural and Indigenous Australian patients.

## Contribution

This is the first study to analyze the cost-effectiveness of implementing intracranial SRS in a regional Australian cancer center.

## Key findings

- Regional brain SRS treatment costs AUD 760 less per course than metropolitan treatment.
- Median survival was 15.7 months with radionecrosis rates comparable to urban centers.
- Local treatment improves access for patients facing logistical and cultural barriers.

## Abstract

Rural and regional Australian patients, especially Aboriginal and Torres Strait Islander patients, are faced with multifaceted challenges when receiving a referral to metropolitan centres for specialist medical care, which affects the uptake of recommended treatment and therefore negatively impacts the outcome. Being able to access specialist care closer to home improves the accessibility and timeliness of recommended treatment. To the best of our knowledge, this is the first study reporting the cost-effectiveness of the implementation of an intracranial SRS service at an Australian regional cancer centre. This study provides evidence to initiate further discussions on the identification of suitable cancer care models to deliver specialist care from funding and policy support perspectives.

Introduction: Intracranial stereotactic radiosurgery (SRS) is a specialised radiotherapy technique that plays an essential role in achieving local control of brain metastases and therefore optimising quality of life for many cancer patients. It also confers a survival benefit in selected patients. Rural and regional Australians may face significant challenges in accessing this treatment, as it is predominantly delivered at metropolitan institutions. We sought to assess the cost-effectiveness of a brain SRS service implemented using local resources at a North Queensland regional hospital from a societal perspective. Methods: We prospectively collected treatment costs and clinical outcomes for a consecutive cohort of patients who received SRS for intracranial metastatic lesions at a regional cancer centre since the implementation of the brain SRS program in September 2022. We compared the healthcare and non-healthcare costs (e.g., travel and informal care) with the costs that would have otherwise been incurred if patients were referred to metropolitan centres in the state capital. Clinical outcomes incorporated overall survival, intracranial disease control rates, and incidence of radiation necrosis. Clinical outcome data of the metropolitan centres were derived from the published literature. Results: A total of 34 patients received treatment during the study period. Their median age was 65 years (range: 49–78 years). Around 47% received adjuvant SRS following surgical resection, and the remaining 53% were treated for intact brain metastases. The predominant primary malignancy was non-small cell lung cancer. The mean total cost per course of brain SRS at a regional hospital was AUD 6690, including AUD 5754 for healthcare and AUD 1682 for non-healthcare costs, across 34 patients recruited between September 2022 and August 2024. This was AUD 760 less than that of a course of treatment delivered at a metropolitan hospital. Median survival among the cohort was 15.7 months, and eight patients (24%) developed radionecrosis; these were comparable to published data reported by Australian urban and international institutions. Conclusions: The implementation of a brain SRS service at regional cancer centres utilising existing infrastructure and local expertise has the potential to offer cost-effective treatment to rural and regional cancer patients. This approach improves access for patients who might otherwise face logistics barriers and competing life priorities when seeking treatment in metropolitan centres.