TY - JOUR
T1 - Cost-effectiveness Analysis Comparing Conventional, Hypofractionated, and Intraoperative Radiotherapy for Early-Stage Breast Cancer
AU - Deshmukh, Ashish A.
AU - Shirvani, Shervin M.
AU - Lal, Lincy
AU - Swint, J. Michael
AU - Cantor, Scott B.
AU - Smith, Benjamin D.
AU - Likhacheva, Anna
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Background: Early-stage breast cancer is among the most prevalent and costly malignancies treated in the American health care system. Adjuvant radiotherapy after lumpectomy represents a substantial portion of breast cancer expenditures. The relative value of novel radiotherapeutic approaches such as intraoperative radiotherapy (IORT) and hypofractionated whole breast irradiation (HF-WBI) compared with conventionally fractionated whole breast irradiation (CF-WBI) is unknown. Therefore, we used prospectively collected outcomes from randomized clinical trials (RCTs) to compare the costeffectiveness of these approaches. Methods:We constructed a decision-Analyticmodel that followed women who were treated with lumpectomy for early-stage breast cancer. Recurrence, mortality, complication rates, and utilities (five-year radiation-Associated quality of life scores), were extracted fromRCTs. Costs were based on Medicare reimbursement rates. Cost-effectiveness fromsocietal and health care sector perspectives was estimated considering two scenarios-the first assumes that radiation-Associated disutility persists five years after treatment, and the second assumes that disutility discontinues. Lifetime outcomes were summarized using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses evaluated the robustness of the results. Results: HF-WBI dominated CF-WBI (ie, resulted in higher quality-Adjusted life-years [QALYs] and lower cost) in all scenarios. HF-WBI also had a greater likelihood of cost-effectiveness compared with IORT; under a societal perspective that assumes that radiation-Associated disutility persists, HF-WBI results in an ICER of $17 024 per QALY compared with IORT with a probability of cost-effectiveness of 80% at the $100 000 per QALY willingness-To-pay threshold. If radiation-Associated disutility is assumed to discontinue, the ICER is lower ($11 461/QALY), resulting in an even higher (83%) probability of relative costeffectiveness. The ICER was most sensitive to the probability of metastasis and treatment cost. Conclusions: For women with early-stage breast cancer requiring adjuvant radiotherapy, HF-WBI is cost-effective compared with CF-WBI and IORT.
AB - Background: Early-stage breast cancer is among the most prevalent and costly malignancies treated in the American health care system. Adjuvant radiotherapy after lumpectomy represents a substantial portion of breast cancer expenditures. The relative value of novel radiotherapeutic approaches such as intraoperative radiotherapy (IORT) and hypofractionated whole breast irradiation (HF-WBI) compared with conventionally fractionated whole breast irradiation (CF-WBI) is unknown. Therefore, we used prospectively collected outcomes from randomized clinical trials (RCTs) to compare the costeffectiveness of these approaches. Methods:We constructed a decision-Analyticmodel that followed women who were treated with lumpectomy for early-stage breast cancer. Recurrence, mortality, complication rates, and utilities (five-year radiation-Associated quality of life scores), were extracted fromRCTs. Costs were based on Medicare reimbursement rates. Cost-effectiveness fromsocietal and health care sector perspectives was estimated considering two scenarios-the first assumes that radiation-Associated disutility persists five years after treatment, and the second assumes that disutility discontinues. Lifetime outcomes were summarized using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses evaluated the robustness of the results. Results: HF-WBI dominated CF-WBI (ie, resulted in higher quality-Adjusted life-years [QALYs] and lower cost) in all scenarios. HF-WBI also had a greater likelihood of cost-effectiveness compared with IORT; under a societal perspective that assumes that radiation-Associated disutility persists, HF-WBI results in an ICER of $17 024 per QALY compared with IORT with a probability of cost-effectiveness of 80% at the $100 000 per QALY willingness-To-pay threshold. If radiation-Associated disutility is assumed to discontinue, the ICER is lower ($11 461/QALY), resulting in an even higher (83%) probability of relative costeffectiveness. The ICER was most sensitive to the probability of metastasis and treatment cost. Conclusions: For women with early-stage breast cancer requiring adjuvant radiotherapy, HF-WBI is cost-effective compared with CF-WBI and IORT.
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U2 - 10.1093/jnci/djx068
DO - 10.1093/jnci/djx068
M3 - Article
C2 - 29059428
AN - SCOPUS:85020727963
SN - 0027-8874
VL - 109
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 11
M1 - djx068
ER -