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The concept of ‘value’ in healthcare has been proposed to evaluate the impact of new intervention, taking into account both the outcomes (that matter most to patients) and the cost spent over the total cycle of care. The Health Economics in Radiation Oncology program of the European Society for Radiotherapy and Oncology (ESTRO-HERO) engaged in building a value-based framework, with a focus on radiation oncology (RO) interventions. As a first step, a systematic literature review was done to investigate existing definitions and classification methods for RO innovations, the latter being the focus of this report.

A systematic literature search was carried out in Pubmed and Embase, following the PRISMA reporting guidelines (Fig 1). Only articles with a definition or classification system for innovation, applicable to RO, were withheld. Data extraction, using a pre-defined data collection form, identified the characteristics and any additional information (e.g. type of outcome, quantitative indicators) of each system.

Fig 1: PRISMA

Data extraction is shown in the PRISMA chart (Fig 1). In 25 papers, 15 original reports of classification systems were identified.  Iterative appraisal  difference between categories, additional data extraction and consensus between authors divided the classification systems into two groups.

The first group included 11 systems, categorising innovations according to the perceived magnitude of innovation, with typically a ‘minor’ versus a ‘major’ group. Appraisal shows that differences between these groups is expressed in 5 different ways: resources required, (expected) impact on patients, degree of difference with standard practice, the amount of training or staff required, and a degree of impact on a business model.  These levels of magnitude are labelled, for example, as ‘incremental vs. stepwise’ or ‘continuous vs. discontinuous’ innovations. The remaining 4 systems categorised the innovations according to radiotherapy specific characteristics, such as the type of radiation equipment, mode of delivery, or radiobiological properties. In this more narrative approach, commonly used terms as ‘technique’ or ‘treatment’ are used in different meanings.

This literature review shows there is no widely accepted classification system for innovative interventions in RO. Two major approaches to categorize innovations were identified, suggesting these may be key characteristics of RO that can be used for classification. Still, there remains room for interpretation and a need for a clear  terminology denoting commonly used RO characteristics.

Building on these data, the ESTRO-HERO project will define what is required for a categorisation of RO innovations in a value-based healthcare context. These categories should help prioritise what outcomes or level of evidence is required to justify implementation or reimbursement, facilitating early access to innovations that could benefit the patient.