Energy-saving radiotherapy paths: Cost-effectiveness analysis of environmental health co-benefits.

15 Background: As healthcare systems seek to optimize quality and costs, environmentally sustainable practices can support high-value care. 1,2 Radiation therapy is energy-intensive, presenting opportunities to reduce resource use without compromising clinical outcomes. Hypofractionated radiotherapy (RT)—fewer, higher-dose treatments—is a guideline-endorsed approach for many malignancies and may offer economic and environmental benefits. 3 We evaluated the cost-effectiveness of hypofractionated vs. conventional RT based on energy utilization and pollution-related health impacts, quantified with disability-adjusted life years (DALYs). Methods: We modeled the energy use and pollution burden of conventional, hypofractionated, and ultra-hypofractionated RT for breast and prostate cancers using prior life cycle assessment data. 3 Energy costs were calculated with institutional utility rates ($1.82/therm, $0.19/kWh). Environmental impacts were translated to DALYs lost with established midpoint-to-endpoint conversion factors. 3 We estimated per-patient savings and, using 2019 National Cancer Database treatment volumes, extrapolated national-level impact. Results: Hypofractionated and ultra-hypofractionated RT were both cost- and DALY-saving relative to conventional RT. For breast cancer, 15- and 5-fraction regimens saved $1,493 and $2,680 per patient and saved 0.0034 and 0.0063 pollution-associated DALYs, respectively. For prostate cancer, corresponding per-patient savings were $1,484 and $3,037 and 0.0035 and 0.0077 DALYs. Modeling ultra-hypofractionated RT for clinically eligible patients (n=49,909; per UK FAST/-Forward, START-B trials), suggested annual national savings up to $133.8 million and 314 DALYs. 5,6 Conclusions: Evidence-based, high-value treatments—such as hypofractionated RT—can reduce costs and maintain outcomes for eligible patients. When scaled, these approaches may offer environmental co-benefits, supporting sustainable cancer care. 1 PMID:38011607, 2 37024422, 3 38821084, 5 32580883, 6 18355913. Energy Cost OD GHG A C NC RE DALYs Cost Savings DALY Savings Breast: Conventional (25-33 fractions) RT $3,624.83 0.0018 12,800 16.20 0.0004 0.0012 8.87 0.0089 - - Hypofractionated (15) $2,132.13 0.0012 8,150 10.10 0.0003 0.0007 5.22 0.0055 $1,492.69 0.0034 Ultra- hypofractionated (5) $945.16 0.0006 4,330 5.06 0.0001 0.0003 2.22 0.0026 $2,679.67 0.0063 Prostate: Conventional (28 or 38-45 fractions) RT $4,133.46 0.0021 14,800 18.80 0.0005 0.0014 10.40 0.0104 - - Hypofractionated (20) $2,649.92 0.0014 10,100 12.60 0.0003 0.0012 6.72 0.0069 $1,483.54 0.0035 Ultra-hypofractionated (5) $1,096.73 0.0006 4,330 5.06 0.0003 0.0004 2.22 0.0026 $3,036.73 0.0077 OD: ozone depletion (kg CFC-11e), GHG: greenhouse gas (kg CO2e), A: acidification (kg SO2e), C: carcinogens (CTUh), NC: non-carcinogens (CTUh), RE: respiratory effects (kg PM2.5).