6/26/2014

1

Building a Global Brachytherapy Community

• Andre‐Guy Martin, MD, MSc, FRCP and Tim R. Williams, MD– The Need for a Global Brachytherapy Community

– The International Cancer Expert Corps

– The GEC‐ESTRO Perspective on the Globalization of Brachytherapy

– Brachytherapy In China

– The Concept of a Global Brachytherapy Community

– Panel Discussion

– Contact information for LinkedIn Group

Global Brachytherapy Macroeconomics

Tim R. Williams, MDMedical Director, Radiation Oncology

The Lynn Cancer InstituteBoca Raton, Florida

6/26/2014

2

Selected Countries:Greater than four month weight for elective surgery

Blandon, et al, Health Affairs 21(3):182(2002)         www.healthaffairs.org

6/26/2014

3

Advanced Technology in CanadaInterventional Procedures

Baerlocher, CMAJ 176(5):616 (2007)

Advanced Technology in Canada

• Complex mix of decentralized national, provincial, and local authorities

• At the federal level regulatory approval comes from• At the federal level, regulatory approval comes from the Therapeutic Products Directorate of Health Canada

• Requires manufacturers to submit scientific data on safety, efficacy, and quality

• Health Technology Assessment organizations have been established at many provincial and local levelsbeen established at many provincial and local levels to “assist” hospitals and other agencies with adoption decisions

6/26/2014

4

New Technology in the UK

• NICE – National Institute for Clinical Evidence

• NASTY – Not Available So Treat YourselfSo Treat Yourself

http://nursesforreform.wordpress.com/2006/11/06/so‐long‐as‐nice‐is‐nasty‐you‐will‐only‐pay‐twice/

Advanced Technology in the UK

http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/398/398i.pdf

6/26/2014

5

Health Spending in Central and East Europe

Waters et al, Health Affairs 27(3):478 (2008)   www.healthaffairs.org

Asian Countries: Out of Pocket Expenses

Yip and Hsiao, Health Affairs 23(3):10 (2008)       www.healthaffairs.org

6/26/2014

6

Selected Countries:Overall Satisfaction with Health Care System

Blandon, et al, Health Affairs 21(3):182(2002).        www.healthaffairs.org

Global Radiation center and Brachy center development

7,000

8,000

2,000

3,000

4,000

5,000

6,000

0

1,000

2007 2008 2009 2010 2011 2012 E 2013 E 2014

Global RC Global BC

NUC‐T584‐02Source: Nucletron internal survey estimates afterloaders excluding electronic Brachy .

6/26/2014

7

Global Radiation/Brachytherapy center development and afterloader installed base.

7000

8000

7,000

8,000

2000

3000

4000

5000

6000

2,000

3,000

4,000

5,000

6,000

# afterload

ers

radiation/brachytherap

y centers

0

1000

0

1,000

2007 2008 2009 2010 2011 2012 E 2013 E 2014

# 

Afterloaders Radation centers Brachy centers

NUC‐T584‐02Source: Nucletron internal survey estimates afterloaders excluding electronic Brachy .

Global Brachytherapy market adoption decreased from 45% in 2010 to 44% in 2011. Number of Brachy centers in APAC decreased the most, mainly in China.

Europe/Aflame 201149%

Global 2011

RNA 2010

RNA 2011

APAC 2010

APAC 2011

Europe/Aflame 2010

44%

42%

46%

37%

44%

48%

NUC‐T584‐02

0 1000 2000 3000 4000 5000 6000 7000

Global 2010

Global 2011

Radiation center with Brachy facility Radiation Centers

45%

Source: Nucletron internal survey estimates afterloaders excluding electronic Brachy .

6/26/2014

8

Brachy center development by region

1,200

1,400

400

600

800

1,000

0

200

2007 2008 2009 2010 2011 2012 E 2013 E 2014

RNA BC E+A BC APAC BC

NUC‐T584‐02Source: Nucletron internal survey estimates afterloaders excluding electronic Brachy .

Brachy adoption development 

50%

55%

60%

15%

20%

25%

30%

35%

40%

45%

50%

0%

5%

10%

2007 2008 2009 2010 2011 2012 E 2013 E 2014

Global RNA Europe&Aflame APAC

NUC‐T584‐02Source: Nucletron internal survey estimates afterloaders excluding electronic Brachy .

6/26/2014

9

Global brachy adoption is 44% of RT sites. Large overall RT adoption unmet need exists in emerging markets (2011)

7

Radiation/Brachy centers and afterloaders per million inhabitants 

1

2

3

4

5

6

# per m

illion inhab

itan

ts

0

World Asia Europe NA Latam ME ANZ

Radiation centers per million inhabitants Brachy centers per million inhabitants

Afterloaders per million inhabitants

17

Building a Global Brachytherapy Community

• Andre‐Guy Martin, MD, MSc, FRCP and Tim R. Williams, MD

– The Need for a Global Brachytherapy Community

– The International Cancer Expert Corps

– The GEC‐ESTRO Perspective on the Globalization of Brachytherapy

– Brachytherapy In Chinay py

– The Concept of a Global Brachytherapy Community

– Panel Discussion

– Contact information for LinkedIn Group

6/26/2014

10

Linkedin BrachyNext User’s 2014 Group

• Log on to Linkedin.com

• Search “BrachyNext2014”

• Click “Join”

• Post a question, start a conversation, request information, search for equipment, establish a cooperative relationship with another center

• And much more! 

6/26/2014

11

Linkedin BrachyNext 2014 Group