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In times of workforce shortages, limited machine availability, and rising patient numbers, the study aims to identify which fractionation approach offers the highest value in terms of efficiency and economic sustainability, aligning with a\u00a0value-based healthcare framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Economic models were developed using German reimbursement data (EBM), treatment costs, machine usage, and realistic patient volumes. Three breast cancer fractionation schemes (conventional NF with 30\u00a0fractions, i.e., 25\u00a0fractions to the whole breast +5\u00a0boost fractions), NF with simultaneous integrated boost (SIB) comprising 28\u00a0fractions, and HF with 20\u00a0fractions (15\u00a0fractions to the whole breast +5\u00a0boost fractions) as well as two prostate cancer regimens (39\u202f\u00d7\u20092.0\u202fGy versus 20\u202f\u00d7\u20093.0\u202fGy) were compared. A\u00a0standardized clinic setup with two linear accelerators and defined full-time staff was assumed. Analyses included cost, break-even points, contribution margins, and personnel needs in both scenarios (HF and NF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite lower reimbursement per case, HF regimens yielded significantly higher economic efficiency due to increased patient throughput and reduced staff-time per treatment. Over 10\u00a0years, the total revenue per linear accelerator for HF breast cancer treatments reached approximately \u20ac\u202f56.9 million, compared to \u20ac\u202f40.2 million and \u20ac\u202f46.6 million for the two NF approaches. A\u00a0one-time investment of \u20ac\u202f50,000 for implementing HF (e.g., for software, training, and workflow optimization) could be amortized within a\u00a0few days, depending on the scenario. Simulation models further demonstrated substantial efficiency gains under hypofractionation without the need to expand machine capacity\u2014an important strategy amidst staffing shortages and increasing demand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>When supported by efficient clinic organization and sufficient patient volume, HF offers clear economic advantages over traditional fractionation schemes. However, for widespread implementation, structural reform of the current outpatient reimbursement system is desirable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-025-02484-y","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T11:51:39Z","timestamp":1764157899000},"page":"319-329","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["From fractionation to financials: economic and clinical implications of hypofractionation in German outpatient radiotherapy practice"],"prefix":"10.1007","volume":"202","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4981-7217","authenticated-orcid":false,"given":"Anastassia","family":"L\u00f6ser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Huth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akvile","family":"Juskeviciute","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Sophie","family":"Mehdorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Fl\u00fch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"B\u00fcltmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oksana","family":"Zemskova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larysa","family":"Liubich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"von Ohlen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cedric","family":"Carl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alla","family":"Smagarynska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Rades","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"2484_CR1","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s00066-023-02105-6","volume":"199","author":"R Fietkau","year":"2023","unstructured":"Fietkau\u00a0R, H\u00f6ller\u00a0U, Krause\u00a0M et\u00a0al (2023in) Strukturelle, prozedurale und personelle Voraussetzung f\u00fcr die Erbringung radioonkologischer und strahlentherapeutischer Leistungen 2023 in Deutschland \u2013 ein Positionspapier der Deutschen Gesellschaft f\u00fcr Radioonkologie (DEGRO). 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