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Original article
peer-reviewed

Access to Stereotactic Radiosurgery: Identification of Existing Disparities and a Modest Proposal to Reduce Them



Abstract

Introduction

Despite the abundance of literature demonstrating the safety, efficacy, and cost-effectiveness of radiosurgery, access to radiosurgery in some parts of the world remains limited. The purpose of this report is to identify disparities for stereotactic radiosurgery (SRS) and suggest possible solutions.

Methods

In this study, we only focus on one SRS device (Gamma Knife) for SRS availability and cost data.  We utilized information from Elekta AB to identify Gamma Knife device sales and the records of the World Bank in order to calculate the ratio of Gamma Knife devices per capita.  According to evidence-based data of medical oncology in the United States of America (USA), we assumed that 18% of gross domestic product (GDP) goes to healthcare spending, approximately 5% of healthcare spending goes to cancer care, and up to 30% of cancer care could be spent on radiosurgery. 

Results

As of 2013, one Gamma Knife unit is available for approximately three million people in USA, Canada, Japan, and the Republic of Korea. In contrast, there is one Gamma Knife unit for 370 million people in Africa, 90 million people in China, 47 million people in Central and Latin America, 43 million people in Asia (excluding China, Japan, and the Republic of Korea), 36 million people in Australia, and 15 million people in Europe.

According to their respective GDPs, these regions can afford to purchase the following numbers of Gamma Knife devices, respectively (assuming a unit cost of $4 million): European Union - 11,225, USA - 9,400, East Asia and Pacific region - 7,054, Latin America and Caribbean - 3,600, Middle East and North Africa - 1,039, and sub-Saharan Africa - 869.

Regional medical policies in West Africa, South Africa, and East Africa could have a significant beneficial effect by making radiosurgery accessible to people in these resource-limited regions.

Conclusions

Stereotactic devices per patient population ratios and GKRS device cost relative to GDP vary tremendously. These factors likely affect patient access to stereotactic radiosurgery. Collaboration of regional medical groups, institutions providing radiosurgical care, and both government and non-governmental organizations could help reduce these limitations to care and improve access to SRS, particularly in resource constrained countries.



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Original article
peer-reviewed

Access to Stereotactic Radiosurgery: Identification of Existing Disparities and a Modest Proposal to Reduce Them


Author Information

Francis Fezeu Corresponding Author

Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia

Ahmed J. Awad

Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

Colin J. Przybylowski

Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA

Robert M. Starke

Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Yuval Grober

Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

David Schlesinger

Department of Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia

Cheng-chia Lee

Department of Neurosurgery, Taipei Veterans Genenral Hospital

Zhiyuan Xu

Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Jason Sheehan

University of Virginia School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: David Schlesinger declare(s) a grant from Elekta. The research grant was used for other studies not directly related to this article. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Access to Stereotactic Radiosurgery: Identification of Existing Disparities and a Modest Proposal to Reduce Them


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Original article
peer-reviewed

Access to Stereotactic Radiosurgery: Identification of Existing Disparities and a Modest Proposal to Reduce Them

  • Author Information
    Francis Fezeu Corresponding Author

    Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia

    Ahmed J. Awad

    Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

    Colin J. Przybylowski

    Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA

    Robert M. Starke

    Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

    Yuval Grober

    Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

    David Schlesinger

    Department of Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia

    Cheng-chia Lee

    Department of Neurosurgery, Taipei Veterans Genenral Hospital

    Zhiyuan Xu

    Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

    Jason Sheehan

    University of Virginia School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: David Schlesinger declare(s) a grant from Elekta. The research grant was used for other studies not directly related to this article. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 20, 2014

    DOI

    10.7759/cureus.157

    Cite this article as:

    Fezeu F, Awad A J, Przybylowski C J, et al. (January 20, 2014) Access to Stereotactic Radiosurgery: Identification of Existing Disparities and a Modest Proposal to Reduce Them. Cureus 6(1): e157. doi:10.7759/cureus.157

    Publication history

    Received by Cureus: December 03, 2013
    Peer review began: December 04, 2013
    Published: January 20, 2014

    Copyright

    © Copyright 2014
    Fezeu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction

Despite the abundance of literature demonstrating the safety, efficacy, and cost-effectiveness of radiosurgery, access to radiosurgery in some parts of the world remains limited. The purpose of this report is to identify disparities for stereotactic radiosurgery (SRS) and suggest possible solutions.

Methods

In this study, we only focus on one SRS device (Gamma Knife) for SRS availability and cost data.  We utilized information from Elekta AB to identify Gamma Knife device sales and the records of the World Bank in order to calculate the ratio of Gamma Knife devices per capita.  According to evidence-based data of medical oncology in the United States of America (USA), we assumed that 18% of gross domestic product (GDP) goes to healthcare spending, approximately 5% of healthcare spending goes to cancer care, and up to 30% of cancer care could be spent on radiosurgery. 

Results

As of 2013, one Gamma Knife unit is available for approximately three million people in USA, Canada, Japan, and the Republic of Korea. In contrast, there is one Gamma Knife unit for 370 million people in Africa, 90 million people in China, 47 million people in Central and Latin America, 43 million people in Asia (excluding China, Japan, and the Republic of Korea), 36 million people in Australia, and 15 million people in Europe.

According to their respective GDPs, these regions can afford to purchase the following numbers of Gamma Knife devices, respectively (assuming a unit cost of $4 million): European Union - 11,225, USA - 9,400, East Asia and Pacific region - 7,054, Latin America and Caribbean - 3,600, Middle East and North Africa - 1,039, and sub-Saharan Africa - 869.

Regional medical policies in West Africa, South Africa, and East Africa could have a significant beneficial effect by making radiosurgery accessible to people in these resource-limited regions.

Conclusions

Stereotactic devices per patient population ratios and GKRS device cost relative to GDP vary tremendously. These factors likely affect patient access to stereotactic radiosurgery. Collaboration of regional medical groups, institutions providing radiosurgical care, and both government and non-governmental organizations could help reduce these limitations to care and improve access to SRS, particularly in resource constrained countries.



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