Cost analysis of radiotherapy equipment in public healthcare facilities of Tamil Nadu, South India.

BACKGROUND: This study examines the economic costs of radiotherapy equipment, linear accelerator (LINAC), Cobalt-60 teletherapy unit, and high-dose-rate (HDR) brachytherapy across secondary and tertiary public healthcare facilities in Tamil Nadu. The objective was to evaluate per-procedure costs from both health system and societal perspectives to determine financial sustainability and the impact of patient throughput on resource utilization. METHODS: The study was conducted from February to September 2023, using cross-sectional patient surveys and retrospective record reviews in facilities with radiotherapy services. Costs including capital, maintenance, human resources, electricity, and out-of-pocket expenses were assessed from both health system and societal perspectives. Cost variations were analyzed by utilization levels, with validation through triangulation and sensitivity analysis. RESULTS: During the inception year, per-procedure costs were highest for HDR brachytherapy due to low initial utilization (n = 253), while LINAC incurred the highest capital expenditure (Indian Rupees [INR] 170.8 million; $2.07 million). In the regular functioning phase, per-procedure costs declined substantially across all modalities as utilization increased. Cobalt-60 teletherapy unit demonstrated the lowest per-procedure cost (INR 7612), followed by HDR brachytherapy, whereas LINAC remained the most expensive modality from both health system and societal perspectives. These findings highlight the strong influence of utilization on cost efficiency. CONCLUSION: Results indicated that higher patient utilization rates significantly reduce per-procedure costs across all equipment types, with LINAC having the highest per-procedure cost and HDR brachytherapy having the highest per-procedure cost during inception due to low throughput. Strategic recommendations, including public-private partnerships, can enhance accessibility and ensure sustainable, equitable radiotherapy services across Tamil Nadu's healthcare system.