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Hospitals are paid for each radiotherapy session, so a proven five-session course earns less than an unproven twenty-five-session one. Paying per course removes the reason to give more treatment than needed.
Payers move from per-fraction to episode-based or per-course payment for radiotherapy, with the price set by indication and independent of fraction number, and with a quality bonus for adherence to evidence-based fractionation guidelines. Randomised trials (FAST-Forward, CHHiP, PACE-B, the Dutch and Canadian hypofractionation trials) have shown that shorter courses are equivalent for breast and prostate cancer, yet uptake lags for years in fee-for-service systems. The US Radiation Oncology Model was designed on this principle; implementing it widely, and in other countries, aligns payment with evidence and frees capacity.
Shares Payers fund trials of cheaper, shorter or lower-dose versions of expensive treatments, Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Surgery and radiotherapy cure most, get least, IMRT / IGRT (modern external beam).
Shares Incentives reward me-too drugs and marginal gains, Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam).
Shares Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam), HR-positive / HER2-negative breast cancer.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Core-funded radiotherapy trials infrastructure with central quality assurance, Surgery and radiotherapy cure most, get least, IMRT / IGRT (modern external beam).
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Surgery and radiotherapy cure most, get least, HR-positive / HER2-negative breast cancer, Prostate cancer.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Incentives reward me-too drugs and marginal gains, Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy).
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Core-funded radiotherapy trials infrastructure with central quality assurance, Surgery and radiotherapy cure most, get least, SBRT / SABR (stereotactic radiotherapy).
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Surgery and radiotherapy cure most, get least, HR-positive / HER2-negative breast cancer, Prostate cancer.