title: Economic consequence of local control with radiotherapy: cost analysis of internal mammary and medial supraclavicular lymph node radiotherapy in breast cancer.
abstract: OBJECTIVE
  To investigate the financial implications of radiotherapy (RT) to the internal mammary and medial supraclavicular lymph node chain (IM-MS) in postoperative breast cancer.
  
  
  METHODS
  A cost-effectiveness and cost-utility analysis were performed, using Markov models, comparing the early and delayed costs and effects of IM-MS during a 20-year time span from a societal viewpoint. The outcome estimates were based on Level I evidence from postoperative RT literature and the cost estimates on the standard practice of the Leuven University Hospitals, with the RT costs derived from an activity-based costing program developed in the department.
  
  
  RESULTS
  On the basis of the assumptions of the model and seen during a 20-year time span, primary treatment including IM-MS RT results in a cost savings (approximately 10,000) compared with a strategy without RT. Because IM-MS RT also results in better clinical effectiveness and greater quality of life, the treatment with IM-MS dominates the approach without IM-MS. Sensitivity analyses confirmed the robustness of these results in all tested circumstances. Although threshold values were found for the cost of IM-MS, the cost at relapse, and the quality of life after treatment, these were substantially different from the baseline estimates, indicating that it is very unlikely that omitting IM-MS would become superior.
  
  
  CONCLUSIONS
  This ex-ante cost evaluation of IM-MS RT showed that the upfront costs of locoregional RT are easily compensated for by avoiding the costs of treating locoregional and distant relapse at a later stage. The cost-sparing effect of RT should, however, be evaluated for a sufficiently long time span and is most specifically found in tumors with a rather slow natural history and a multitude of available systemic treatments at relapse, such as breast cancer.
authors.affiliation: Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium. yolande.lievens@uz.kuleuven.ac.be
authors.forename: Yolande
authors.initials: Y
authors.lastname: Lievens
authors.forename: Katrien
authors.initials: K
authors.lastname: Kesteloot
authors.forename: Walter
authors.initials: W
authors.lastname: van den Bogaert
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000191:economics* / Q000379:methods; D008390:Markov Chains; D018803:Models, Economic