Variations in demand across England for the MR-linac technology, simulated utilising local-level demographic and cancer data in the Malthus Project

Introduction: Cancer incidence varies across England, which affects the local-level demand for treatments. The MR-linac is a new radiotherapy technology that combines imaging and treatment. In this study, we model the demand and demand variations for the MR-linac across England.
Method: Initial clinical indications were provided by the MR-linac consortium and introduced into the Malthus radiotherapy clinical decision trees. The Malthus model contains Clinical Commissioning Group (CCG) population, cancer incidence and stage presentation data (for lung and prostate) and simulated the demand for the MR-linac for all CCGs and Radiotherapy Operational Delivery Networks (RODN) across England.
Results: Based on the initial target clinical indications, the MR-linac could service 16% of England’s fraction burden. The simulated fraction per million population (#/mill) demand per annum varied between 3 000 #/mill and 10 600 #/mill at CCG level. Focussing only on the cancer population, the simulated fractions per 1 000 cancer cases (#/1k cases) demand per annum ranges from 1 028 #/1k cases to 1 195 #/1k cases. If a national average for #/mill demand were used then, at RODN level, the variation from actual annual demand ranges from over-estimation of 8 400 fractions to under-estimation of 5 800 fractions. When using the national average #/1k cases, RODN demand varies from an over-estimation of 3 200 fractions to an under-estimation of 3 000 fractions.
Conclusions: Planning cancer services is complex due to regional variations in cancer burden. The variations in simulated demand of the MR-linac highlights the requirement to use local-level data when planning to introduce a new technology.