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Cost effectiveness of new breast cancer radiotherapy technologies in diverse populations

  • Epidemiology
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Abstract

Accelerated partial breast radiotherapy (RT) strategies (3-D conformal external-beam RT (3-D CRT) and brachytherapy with balloon catheter) reduce time and transportation burdens of whole breast RT for breast cancer. Long-term clinical trial evidence is unavailable for accelerated modalities, but uncertainty might be acceptable for patients likely to receive suboptimal whole breast RT. The objective of this study is to assess the cost effectiveness of accelerated partial breast RT compared to on-time and delayed whole breast RT. The design used in this study is decision analytic Markov model. The data sources are published literature; and national/federal sources. The target population of this study is a hypothetical cohort of 60 years old women previously treated with breast-conserving surgery for node-negative, estrogen receptor-positive breast cancer with tumors <1 cm. The time horizon is 15 years, and the perspective is societal. The interventions are whole breast RT, 3-D CRT, and brachytherapy breast irradiation. The outcome measures are costs (2008 US$), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. The base-case results were: 3-D CRT was the preferred strategy, costing on average $10,800 and yielding 11.21 QALYs. On-time whole breast RT costs $368,000/QALY compared to 3-D CRT, above the $100,000/QALY WTP threshold. 3-D CRT was also preferred over delayed whole breast RT. Brachytherapy was never preferred. Sensitivity analysis indicated that the results were sensitive to the rate of recurrence outside the initial tumor quadrant (“elsewhere failure”) in one-way analysis. Probabilistic sensitivity analysis indicated that results were sensitive to parameter uncertainty, and that the elsewhere-failure rate and treatment preferences may drive results. The limitation of this study is that efficacy estimates are derived from studies that may not fully represent the population modeled. As a conclusion, 3-D CRT was preferred to whole breast RT and for women likely to delay RT, indicating that 3-D CRT could be targeted more efficiently before randomized trial evidence.

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Acknowledgments

This work was supported in part by the Center for Education and Research on Therapeutics (Agency of Health Research and Quality [Grant Number 1U18-HS016075]). The study was deemed exempt by the Institutional Review Board at Weill Cornell Medical College. Alvin I. Mushlin, MD, ScM, Bruce R. Schackman, PhD, and Natasha K. Stout, PhD, suggested critical revisions but any mistakes are the authors’ alone.

Conflict of interest

The authors have no conflicts of interest to disclose. This study was not supported by a pharmaceutical company.

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Authors and Affiliations

  1. New York University School of Medicine and Cancer Institute, 550 First Avenue, VZ30, Suite 611, New York, NY, 10016, USA

    Heather Taffet Gold

  2. Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA

    Mary Katherine Hayes

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  1. Heather Taffet Gold
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  2. Mary Katherine Hayes
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Correspondence to Heather Taffet Gold.

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Heather Taffet Gold and Mary Katherine Hayes contributed equally to this work.

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Gold, H.T., Hayes, M.K. Cost effectiveness of new breast cancer radiotherapy technologies in diverse populations. Breast Cancer Res Treat 136, 221–229 (2012). https://doi.org/10.1007/s10549-012-2242-y

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