title: Cost-efficacy of acceleration partial-breast irradiation compared with whole-breast irradiation.
abstract: 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.
authors: Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO 63108, USA. csshah27@hotmail.com
authors: Chirag
authors: C
authors: Shah
authors: Thomas B
authors: TB
authors: Lanni
authors: Harkiran
authors: H
authors: Saini
authors: Anish
authors: A
authors: Nanavati
authors: J Ben
authors: JB
authors: Wilkinson
authors: Shahed
authors: S
authors: Badiyan
authors: Frank
authors: F
authors: Vicini
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D020266:Radiotherapy, Conformal / Q000191:economics*; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics*; D012008:Recurrence