Cost effectiveness of a radiation therapy simulator: a model for the determination of need

The requirement for a certificate-of-need for capital expenditures of $100,000 or more has placed a major constraint on purchases of new medical equipment. Consideration of a first principles argument has not proven compelling to the planning agencies in justifying the purchase of a radiation therapy simulator. Thus a strategy based on cost-effectiveness and the consequences of survival in successfully treated patients is proposed for equipment justification. We have reviewed the records of 18-month survivors among patients with lung cancer that were treated by irradiation; we observed 3 spinal cord injuries in non-simulated patients, whereas none were observed in patients who had the benefit of simulation. Considering the societal costs of spinal cord injury, a cost-benefit analysis of a simulator justifies the expense of this equipment