title: Cost-effectiveness of 3-dimensional conformal radiotherapy and applicator-based brachytherapy in the delivery of accelerated partial breast irradiation.
abstract: OBJECTIVE
  To compare reimbursement and cost efficacy between accelerated partial breast irradiation (APBI) techniques.
  
  
  METHODS
  Four hundred fifty-three patients were treated with APBI using either 3-dimensional conformal radiotherapy (3D-CRT, n=207) or balloon-based brachytherapy (BB) [single-lumen (SL, n=161) and multilumen (ML, n=85)] between March 2000 and October 2011. To evaluate cost-effectiveness, reimbursement by treatment technique was calculated based on 2011 Medicare schedules. Facility costs were generated by technique based on ICD-9 codes. Incremental cost effectiveness ratios (ICER), which compares cost with clinical outcomes, were calculated according to the difference in reimbursement to the criteria being evaluated.
  
  
  RESULTS
  With a median follow-up of 3.6 years, the 5-year rate of local recurrence was 1.9% for all patients (3D-CRT, 0%; BB, 4.1%; P=0.23). When pooled, BB patients had a significant improvement in excellent/good cosmesis (91.6% vs. 80.0%; P=0.03). Rates of combined grade 2 or higher dermatitis, hyper/hypopigmentation, pain, or fibrosis per technique were 62%, 28%, and 34% for 3D-CRT, SL, and ML patients, respectively (P=0.26). The ICER per percent improved cosmesis for SL/ML was $519/$850 based on reimbursement and $301/$643 based on cost compared with 3D-CRT.
  
  
  CONCLUSIONS
  On the basis of ICER, brachytherapy for APBI is a cost-effective option with regard to cosmesis and toxicity. This economic analysis suggests the increased cost of applicator-based brachytherapy may be justified in appropriately selected patients.
authors.affiliation: *Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri †Department of Radiation Oncology, Beaumont Cancer Institute, William Beaumont School of Medicine, Oakland University, Royal Oak, MI.
authors.forename: Chirag
authors.initials: C
authors.lastname: Shah
authors.forename: Thomas
authors.initials: T
authors.lastname: Lanni
authors.forename: John Ben
authors.initials: JB
authors.lastname: Wilkinson
authors.forename: Maha
authors.initials: M
authors.lastname: Jawad
authors.forename: Jessica
authors.initials: J
authors.lastname: Wobb
authors.forename: Sameer
authors.initials: S
authors.lastname: Berry
authors.forename: Michelle
authors.initials: M
authors.lastname: Wallace
authors.forename: Peter
authors.initials: P
authors.lastname: Chen
authors.forename: Inga S
authors.initials: IS
authors.lastname: Grills
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D001943:Breast Neoplasms / Q000532:radiotherapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007349:Insurance, Health, Reimbursement; D006278:Medicare; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D020266:Radiotherapy, Conformal / Q000191:economics*; D016896:Treatment Outcome; D014481:United States