The aging Belgian population requires ever increasing social and medical care resulting in a  steadily increasing demand for funding.

Furthermore, the incidence of cancer is high and increasing, for some tumours even more so in Belgium and surrounding countries then elsewhere. This will increase the number of cancer treatments and the number of treatments per patient, which will in its turn increase healthcare expenses. Another important factor is the explosive increase of the cost of some systemic treatments offered for specific cancers. The pharmaceutical industry pass on the high development costs of 'targeted therapies' to the cost of the molecule, once approved for distribution. These are just a few reasons for a serious pressure for increased in cancer treatment. This process has been going on for a while, but is expected to evolve more rapidly over the next years.

Radiation oncology does require large and costly treatment machines, located in large and costly treatment vaults. Furthermore, new radiotherapy techniques require additional technical tools to make treatments safer and more precise. Belgian radiotherapy departments have until now tried to follow the technical evolution and have installed the most modern systems. But luckily these machines have a life expectancy of many years, and over 30 patients can be treated on one machine per day. The total cost of a radiation treatment does contain a provision for the used technology, but the largest part is required for the multidisciplinary team running the machines. This total cost is not always adequately covered by the present reimbursement levels which primarily allows for more simple techniques and to a far lesser degree for treatments involving a high level of technology. The amount required for most radiotherapy treatments is less than 4000 Euros, and even if for a limited number of patients the cost is higher than that level it will remain way below 10000 Euros. This might seem a high amount, but in comparison with the cost of a targeted systemic therapy cycles, it is very low indeed.

It is of course not possible to simplify the discussion and 'replace' a costly systemic treatment by a 'less costly' radiotherapy treatment: for each tumour and patient, a specific treatment is required and in daily practice it is rarely required to choose between treatment A or treatment B. More often both A and B are required. But still, in a country like Belgium with a well organised social security we see that some systemic treatments are readily reimbursed, even though some of these treatments have a very limited beneficial effect on patients' comfort or life-expectancy. Radiation oncologist are convinced that many modern radiotherapy treatments are very effective (with very beneficial effects on patient comfort and life expectancy), with an associated cost that is way below other recognised treatments.

Different issues arise however: The quantification of effects of different treatments is very difficult, and can rapidly lead to inaccurate comparisons. Furthermore, a treatment can seem at first sight relatively costly, but if this very precise treatment does NOT induce side effects, it might in the long run be for instance a much better deal than a 'competitive' treatment that seems cheaper but induces more side effects that require the use of medication, physical therapy, bandage material, ... for many years. So in an ideal world one should not look at costs per treatment or per medical speciality based on the reimbursement levels to physicians, but total cost for clinical pathways for a specific disease entity, across different medical specialties, and even including secondary costs related to medication, physical therapy, bandage material and so on.

Radiation departments have been increasing the use of governmental funding over the last years, but have delivered for these efforts world class radiotherapy treatments that can compete with what is on offer in surrounding countries, possibly at a lower cost than abroad. Furthermore, the Belgian radiation oncology world has continued to invest in measurable quality, and is open to analysis of obtained outcomes.

Notwithstanding the high quality levels at this moment, we have to be careful: the present reimbursement model does not leave margins to keep investing in new technology to make treatments even more precise and safe beyond what has been obtained until now. BRAVO is however confident that policy makers and representatives of the radiation-oncologists will collaborate to gradually move to a more adapted financing scheme in the future.