• Lievens Y, Grau C. Health economics in radiation oncology: introducing the ESTRO HERO project. Radiother Oncol 2012 Apr;103(1):109-12

• Lievens Y, Defourny N, Coffey M, et al. Radiotherapy staffing in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol 2014;112:178– 86

• Grau C, Defourny N, Malicki J, et al. Radiotherapy equipment and departments in the European countries: final results from the ESTRO-HERO survey. Radiother Oncol 2014;112:155–64

• Dunscombe P, Grau C, Defourny N, et al. Guidelines for equipment and staffing of radiotherapy facilities in the European countries: final results of the ESTRO-HERO survey., Radiother Oncol. 2014 Aug;112(2):165-77

• Lievens Y, Dunscombe P, Defourny N, et al. HERO (Health Economics in Radiation Oncology): a pan-European project on radiotherapy resources and needs. C. Clin Oncol (R Coll Radiol). 2015 Feb;27(2):115-24.

• Borras JM, Barton M, Grau C, et al. The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population-based analysis by the ESTRO-HERO project. Radiother Oncol. 2015 Jul;116(1):45-50.

• Borràs JM, Lievens Y, Dunscombe P, et al. The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis.  Radiother Oncol. 2015 Jul;116(1):38-44

• Borras, J. M., Lievens, Y., Barton, M., et al. How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis. Radiotherapy and Oncology 2016, 119(1), 5-11.

• Defourny, N., Dunscombe, P., Perrier, L., et al. Cost evaluations of radiotherapy: What do we know? An ESTRO-HERO analysis. Radiotherapy and Oncology 2016, 121(3), 468-474.

• Borras JM, Grau C, Corral J, Wong K, Barton MB, Ferlay J, Bray F, Lievens Y. Estimating the number of fractions by tumour site for European countries in 2012 and 2025: An ESTRO-HERO analysis. Radiother Oncol 2018;126(2):198-204.

• Lievens Y, Audisio R, Banks I, Collette L, Grau C, Oliver K, Price R, Aggarwal A. Towards an evidence-informed value scale for surgical and radiation oncology: a multi-stakeholder perspective. Lancet Oncol. 2019;20(2):e112-23.

• Defourny N, Perrier L, Borras JM, Coffey M, Corral J, Hoozée S, Loon JV, Grau C, Lievens Y. National costs and resource requirements of external beam radiotherapy: A time-driven activity-based costing model from the ESTRO-HERO project. Radiother Oncol. 2019;138:187-94. 

• Defourny N, Monten C, Grau C, Lievens Y, Perrier L. Critical review and quality-assessment of cost analyses in radiotherapy: How reliable are the data? Radiother Oncol. 2019 Dec;141:14-26.

• Lievens Y, Defourny N, Corral J, Gasparotto C, Grau C, Borras JM; ESTRO–HERO Consortium Collaborators. How public health services pay for radiotherapy in Europe: an ESTRO-HERO analysis of reimbursement. Lancet Oncol. 2020 Jan;21(1):e42-e54

• Lievens Y, Borras JP, Grau C. Provision and use of radiotherapy in Europe. Mol Oncol 2020 Jul; 14 (7): 1461–1469.

Health care budgets are tight, and health economic evaluations are key to support decision-making: launched in 2010, the HERO project (Health Economics in Radiation Oncology) is developing a knowledge base and a cost accounting model estimating the national cost of radiotherapy (RT). The overall aim is to provide solid data to the RT community to engage with governments, funders and decision makers, and advocate for better funding for RT, better resource planning and ultimately better care for cancer patients.

To accomplish these objectives, the HERO project addresses different dimensions: the provision and accessibility of radiotherapy in Europe, then compared to the need for radiotherapy, and the cost of radiotherapy assessed at national level thanks to a cost-accounting model tailored for radiotherapy, in order to engage in economic evaluations of radiotherapy, e.g. cost-effectiveness and cost-utility.

The project is carried out in close collaboration with the European national societies of radiation oncology. A task force has been formed, consisting of international specialists in the field.

• Provision and accessibility of radiotherapy: Assessment of the actual status of radiotherapy in Europe, in terms of treatments delivered on an annual basis per country, equipment, staffing and guidelines.

• The need for radiotherapy: Definition of an optimum for radiotherapy in Europe, defining the patients who should receive radiotherapy, those that are receiving it - highlighting the existing gap - and the growing future need for RT.

• Cost-accounting programme for RO: Development of a costing tool, providing insight on the national cost of radiotherapy: per treatment, on average and for various tumour types and techniques used, but also on the resources required based on national patterns of care, allowing to perform sensitivity analysis.

• Economic evaluation models for RO. Engagement in economic evaluations of radiotherapy, e.g. cost-effectiveness and cost-utility; estimates on gains in outcome, different costs, different countries, different radiotherapy techniques.