Abstract
BACKGROUND: Radiotherapy access remains inequitable, particularly in geographically isolated regions such as island territories, where centralisation of services often requires long-distance travel for patients. This imposes substantial burdens on patients and their families, potentially resulting in treatment discontinuation or refusal. Decentralised service models, such as satellite radiotherapy units, have emerged as a promising strategy to bring care closer to underserved populations while preserving integration with centralised expertise. However, decentralisation also poses several challenges, including underutilisation, resource duplication, and higher operational costs. In 2022, a satellite radiotherapy unit was established in Fuerteventura (Canary Islands, Spain) to promote equitable access to cancer patients. The economic impact of this unit has not yet been evaluated. OBJECTIVE: To compare the cost of delivering radiotherapy at the satellite unit of Fuerteventura with the cost at the reference centre in Gran Canaria for patients living in Fuerteventura. METHODS: A cost-minimisation analysis was conducted from the perspective of the public health system using 2021 and 2023 data. Direct healthcare costs were estimated based on the annual costs of each facility, adjusted for treatment complexity and volume. Travel-related costs were derived from reimbursement data, including inter-island transport, accommodation and transfers for in-hospital patients. Costs per patient were compared, and the patient volume required for the satellite unit to generate cost-savings was calculated. RESULTS: In 2023, 182 patients received radiotherapy at the Fuerteventura unit, compared to 2,501 at the reference centre in Gran Canaria. The average healthcare cost per patient was €6,855 at the satellite unit and €4,619 in Gran Canaria. However, average travel costs per patient dropped from €1,819 in 2021 (before the satellite unit) to €337 in 2023. Overall, total per-patient cost was €754 higher at the satellite unit in 2023. Our estimates suggest that the unit may generate cost-savings for the healthcare system once patient volume reaches 205 patients per year—a threshold already exceeded in 2024. CONCLUSIONS: The satellite model demonstrates potential to deliver cost-comparable care as patient volumes increase. Moreover, improved proximity to treatment may offer additional access-related benefits, as suggested by previous literature, reinforcing the value of satellite models in promoting equitable access while maintaining high standards of care.