Radiotherapy – learning about the HERO project

Head of Radiotherapy PhysicsThe Health Economics in Radiation Oncology (HERO) project was set up by the European Society for Therapeutic Radiation Oncology (ESTRO) in order to gain a better understanding of the availability and need for radiotherapy in Europe. It also provides health information to inform decision makers on the costs and cost effectiveness of radiotherapy services. Dr Keith Langmack, member of the BIR Oncology and Radiotherapy Special Interest Group (SIG), reports on a recent meeting in Brussels where a new costing model was introduced. He makes the case for multidisciplinary teams to work together to use the model in the UK.

“I was invited to represent the BIR at the ESTRO headquarters on 5 December 2017, one of many representatives from all over Europe all very excited to see the newly developed costing model for radiotherapy and then to go to the European Parliament to discuss the gap in radiotherapy provision across Europe.

The day started with an overview of the HERO project from Professor Cai Grau (Professor of Radiation Oncology at the Institute of Clinical Medicine at Aarhus University, Director of the Danish National Centre for Interventional Research in Radiation Oncology and Chair of the HERO project). He told us that the HERO project had 4 phases: to define the need for radiotherapy, evaluate the current access to radiotherapy, to calculate the cost of radiotherapy, and finally to determine the cost-effectiveness of radiotherapy at a European level. He presented some of the results from phases 1 and 2 [1-4]. These included the conclusion that radiotherapy is only given to around 70% of the patients who could benefit as defined by current guidelines and best-practice, and that socio-economic factors play a big role in the provision of radiotherapy across Europe.

RadiotherapyMost of the rest of the day was taken up with an introduction to the newly developed costing tool by Noémie Defourny, the health economist who has had a major input into developing the model. She explained that this model has been designed to take national level data (e.g. staffing, equipment profile, fractionation) and predict the cost of external beam radiotherapy at a national level. Once base-line data is in place then the effect of changing the parameters on cost (e.g. dose-fractionation, provision of equipment) can be predicted. The cost of brachytherapy and chemotherapy are not included in the model. She then demonstrated the model using a fictional country, Europalia. We then had an opportunity to run the model for ourselves.

The final part of the workshop consisted of presentations from Drs. J F Daisne (Belgium) and Zoltán Takácsi-Nagy (Hungary) to illustrate how they had been piloting the model in their respective countries. This involved a large amount of work collecting the data, however progress was being made. This part of the day was concluded by Professor Josep M. Borras (Director of the Regional Government of Catalonia’s Cancer Plan and Scientific Coordinator of the Spanish Ministry of Health’s Strategy on Cancer) summarising the need for producing national level cancer plans and linking this to the need for effective economic modelling.

We then travelled to the European Parliament for a meeting entitled “Radiation oncology cures cancer today – Help us close the gap in access to radiotherapy and make a difference!” hosted by Mrs Lieve Wierinck MEP (member of the MEPs Against Cancer group). This consisted of a number of presentations from the HERO project. There was then a panel debate chaired by Peter O’Donnell (Associate Editor, European Voice) where a number of learned academic and industry speakers from across Europe talked about meeting the need for radiotherapy in the region.

So what next? As a participant in the workshop it means the BIR has access to the costing model. In the UK we have good data to put into the model. However it would require a multi-professional team to populate all the required data fields. The next step would be looking at the best way to tackle this collaboratively. Having talked with the people involved in developing the model, I am sure ESTRO would be supportive of the implementation of the model at the UK level. It is a very interesting enabler for research on the effects of changes in service delivery. It would be timely to use it with a new radiotherapy service specification being introduced in England.”

Dr Keith LAngmack is Head of Radiotherapy Physics at Nottingham University Hospitals NHS Trust.


  1. Lievens Y and Grau C. Health Economics in Radiation Oncology: Introducing the ESTRO HERO project. Radiotherapy and Oncology 103 (2012) 109–112.
  2. Grau C, Defourny N, Malicki J, et al. Radiotherapy equipment and departments in the European countries: Final results from the ESTRO-HERO survey. Radiotherapy and Oncology 112 (2014) 155–164.
  3. Dunscombe P, Grau C, Defourny N et al. Guidelines for equipment and staffing of Radiotherapy facilities in the European countries: Final results of the ESTRO-HERO survey. Radiotherapy and Oncology 112 (2014) 165–177.
  4. Lievens Y, Defourny N, Coffey M, et al. Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey. Radiotherapy and Oncology 112 (2014) 178–186.