Breast Cancer Research and Treatment

, Volume 138, Issue 1, pp 127–135 | Cite as

Cost-efficacy of acceleration partial-breast irradiation compared with whole-breast irradiation

  • Chirag Shah
  • Thomas B. Lanni
  • Harkiran Saini
  • Anish Nanavati
  • J. Ben Wilkinson
  • Shahed Badiyan
  • Frank Vicini
Clinical trial


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.


Accelerated partial-breast irradiation Breast cancer Whole breast irradiation Breast conservation therapy Cost-efficacy 


Conflict of interest

All authors have no conflicts of interest.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Chirag Shah
    • 1
  • Thomas B. Lanni
    • 2
  • Harkiran Saini
    • 1
  • Anish Nanavati
    • 3
  • J. Ben Wilkinson
    • 2
  • Shahed Badiyan
    • 1
  • Frank Vicini
    • 4
  1. 1.Department of Radiation OncologyWashington University School of MedicineSaint LouisUSA
  2. 2.Department of Radiation OncologyOakland University William Beaumont School of MedicineRoyal OakUSA
  3. 3.Department of OncologyGeorgetown University School of MedicineWashingtonUSA
  4. 4.Michigan Healthcare Professionals/21st Century OncologyFarmington HillsUSA

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