title: Cost comparison of radiation treatment options after lumpectomy for breast cancer.
abstract: BACKGROUND
  Radiation therapy (RT) after lumpectomy for breast cancer can be delivered with several different regimens. We evaluated a cost-minimization strategy to select among RT options.
  
  
  METHODS
  An institutional review board (IRB)-approved retrospective review identified a sample of 100 women who underwent lumpectomy for invasive or in situ breast cancer during 2009. Post lumpectomy RT options included: no radiation in women ≥70 years [T1N0, estrogen receptor (ER)+] per Cancer and Leukemia Group B (CALGB) 9343 (no-RT), accelerated external-beam partial-breast irradiation (APBI), and Canadian fractionation (C-RT), as alternatives to standard whole-breast radiation therapy (WBRT). Eligibility for RT regimens was based on published criteria. RT costs were estimated using the 2011 US Medicare Physician Fee Schedule and average Current Procedural Terminology (CPT) codes billed per regimen at our institution. Costs were modeled in a 1,000-patient theoretical cohort.
  
  
  RESULTS
  Median patient age was 56.5 years (range 32-93 years). Tumor histology included invasive ductal cancer (78 %), ductal carcinoma in situ (DCIS) (15 %), invasive lobular cancer (6 %), and mixed histology (1 %). Median tumor size was 1 cm (range 0.2-5 cm). Estimated per-patient cost of radiation was US$5,341.81 for APBI, US$9,121.98 for C-RT, and US$13,358.37 for WBRT. When patients received the least expensive radiation regimen for which they were eligible, 14 % received no-RT, 44 % received APBI, 7 % received C-RT, and 35 % defaulted to WBRT. Using a cost-minimization strategy, estimated RT costs were US$7.67 million, versus US$13.36 million had all patients received WBRT, representing cost savings of US$5.69 million per 1,000 patients treated.
  
  
  CONCLUSIONS
  A cost-minimization strategy results in a 43 % reduction in estimated radiation costs among women undergoing breast conservation.
authors.affiliation: Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA. rgreenup13@gmail.com
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Greenup
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Camp
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
authors.forename: Julliette
authors.initials: J
authors.lastname: Buckley
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Coopey
authors.forename: Michele
authors.initials: M
authors.lastname: Gadd
authors.forename: Kevin
authors.initials: K
authors.lastname: Hughes
authors.forename: Michelle
authors.initials: M
authors.lastname: Specht
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000191:economics*; D001943:Breast Neoplasms / Q000191:economics* / Q000532:radiotherapy / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000191:economics* / Q000532:radiotherapy / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000191:economics* / Q000532:radiotherapy / Q000601:surgery; D018275:Carcinoma, Lobular / Q000191:economics* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D015412:Mastectomy, Segmental / Q000191:economics; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies