title: Cost Implications of an Evidence-Based Approach to Radiation Treatment After Lumpectomy for Early-Stage Breast Cancer.
abstract: Breast cancer treatment costs are rising, and identification of high-value oncology treatment strategies is increasingly needed. We sought to determine the potential cost savings associated with an evidence-based radiation treatment (RT) approach among women with early-stage breast cancer treated in the United States.
  
  
  
  Using the National Cancer Database, we identified women with T1-T2 N0 invasive breast cancers treated with lumpectomy during 2011. Adjuvant RT regimens were categorized as conventionally fractionated whole-breast irradiation, hypofractionated whole-breast irradiation, and omission of RT. National RT patterns were determined, and RT costs were estimated using the Medicare Physician Fee Schedule.
  
  
  
  Within the 43,247 patient cohort, 64% (n = 27,697) received conventional RT, 13.3% (n = 5,724) received hypofractionated RT, 1.1% (n = 477) received accelerated partial-breast irradiation, and 21.6% (n = 9,349) received no RT. Among patients who were eligible for shorter RT or omission of RT, 57% underwent treatment with longer, more costly regimens. Estimated RT expenditures of the national cohort approximated $420.2 million during 2011, compared with $256.2 million had women been treated with the least expensive regimens for which they were safely eligible. This demonstrated a potential annual savings of $164.0 million, a 39% reduction in associated treatment costs.
  
  
  
  Among women with early-stage breast cancer after lumpectomy, use of an evidence-based approach illustrates an example of high-value care within oncology. Identification of high-value cancer treatment strategies is critically important to maintaining excellence in cancer care while reducing health care expenditures.
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Greenup
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Blitzblau
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Houck
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Julie Ann
authors.initials: JA
authors.lastname: Sosa
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Janet
authors.initials: J
authors.lastname: Horton
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Peppercorn
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.affiliation: Duke University Medical Center; Duke Cancer Institute, Durham, NC; and Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: E Shelley
authors.initials: ES
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy / Q000601:surgery; D003365:Costs and Cost Analysis; D019583:Dose Fractionation, Radiation; D055317:Evidence-Based Practice / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011182:Postoperative Care; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000191:economics*; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor