Cost-efficacy of acceleration partial-breast irradiation compared with whole-breast irradiation
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The purpose of this study was to analyze the cost-efficacy of multiple accelerated partial-breast irradiation (APBI) techniques compared with whole breast irradiation (WBI) delivered utilizing 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT). A previously reported matched-pair analysis consisting of 199 patients receiving WBI and 199 patients receiving interstitial APBI formed the basis of this analysis. Cost analyses included a cost minimization analysis, incremental cost- effectiveness ratio (ICER) analysis, and cost per quality adjusted life year (QALY) analysis. Per 1,000 patients treated, the cost savings with the utilization of APBI compared to WBI IMRT is $14.9 million, $10.9 million, $8.8 million, $5.0 million, and $9.7 million for APBI 3D-CRT, APBI IMRT, APBI single-lumen (SL), APBI multi-lumen (ML), and APBI interstitial, respectively. Per 1,000 patients treated, the cost savings with the utilization of APBI compared to WBI 3D-CRT is $6.0 million, $2.0 million, and $0.7 million for APBI 3D-CRT, APBI IMRT, and APBI interstitial, respectively. The cost per QALY for APBI SL, APBI ML, and APBI interstitial compared with APBI 3D-CRT are $12,273, $66,032, and $546, respectively. When incorporating non-medical costs and cost of recurrences the cost per QALY was $54,698 and $49,009 for APBI ML compared with APBI 3D-CRT. When compared to WBI IMRT, all APBI techniques are cost-effective based on cost minimization, ICER, and QALY analyses. When compared to WBI 3D-CRT, external beam APBI techniques represent a more cost-effective approach based on cost minimization with brachytherapy representing a cost-effective approach based on cost per QALY.
KeywordsAccelerated partial-breast irradiation Breast cancer Whole breast irradiation Breast conservation therapy Cost-efficacy
Conflict of interest
All authors have no conflicts of interest.
- 5.Shah C, Wobb J, Grills I et al (2012) Use of intensity modulated radiation therapy to reduce acute and chronic toxicities of breast cancer patients treated with traditional and accelerated whole breast irradiation. Pract Radiat Oncol [Epub ahead of print]Google Scholar
- 12.National Surgical Adjuvant Breast and Bowel Project/Radiation Therapy Oncology Group (2012) RTOG 0413 Protocol Information. RTOG.org. http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0413. Updated 28 Feb 2011. Accessed 7 Sept 2012
- 13.Lanni T, Keisch M, Shah C et al (2012) A cost comparison analysis of adjuvant radiation therapy techniques after breast-conserving surgery. Breast J 2013 Jan 7 [Epub ahead of print]Google Scholar
- 15.Shah C, Lanni TB Jr, Ghilezan MI et al (2012) Brachytherapy provides comparable outcomes and improved cost-effectiveness in the treatment of low/intermediate risk prostate cancer. Brachytherapy [Epub ahead of print]Google Scholar
- 18.Greenup RA, Camp MS, Taghian AG et al (2012) Cost comparison of radiation treatment options after lumpectomy for breast cancer. Ann Surg Oncol [Epub ahead of print]Google Scholar
- 19.Dragun AE, Pan J, Riley EC et al (2012) Increasing use of elective mastectomy and contralateral prophylactic surgery among breast conservation candidates: a 14-year report from a comprehensive cancer center. Am J Clin Oncol [Epub ahead of print]Google Scholar
- 20.Allemani C, Sant M, Weir HK et al (2012) Breast cancer survival in the US and Europe: a CONCORD high-resolution study. Int J Cancer [Epub ahead of print]Google Scholar