Evaluating radiotherapy options in breast cancer: Does intraoperative radiotherapy represent the most cost-efficacious option?

Chirag Shah, Shahed Badiyan, Shariq Khwaja, Hardeepak Shah, Ami Chitalia, Anish Nanavati, Neilendu Kundu, Vikram Vaka, Thomas B. Lanni, Frank A. Vicini

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37 Scopus citations

Abstract

Introduction This study analyzed the cost-efficacy of intraoperative radiation therapy (IORT) compared with whole-breast irradiation (WBI) and accelerated partial-breast irradiation (APBI) for early-stage breast cancer. Materials and Methods Data for this analysis came from 2 phase III trials: the TARGIT (Targeted Intraoperative Radiotherapy) trial and the ELIOT (Electron Intraoperative Radiotherapy) trial. Cost analyses included a cost-minimization analysis and an incremental cost-effectiveness ratio analysis including a quality-adjusted life-year (QALY) analysis. Cost analyses were performed comparing IORT with WBI delivered using 3-dimensional conformal radiotherapy (3D-CRT), APBI 3D-CRT, APBI delivered with intensity-modulated radiotherapy (IMRT), APBI single-lumen (SL), APBI multilumen (ML), and APBI interstitial (I). Results Per 1000 patients treated, the cost savings with IORT were $3.6-$4.3 million, $1.6-$2.4 million, $3.6-$4.4 million, $7.5-$8.2 million, and $2.8-$3.6 million compared with WBI 3D-CRT, APBI IMRT, APBI SL, APBI ML, and APBI I, respectively, with a cost decrement of $1.6- $2.4 million compared with APBI 3D-CRT based on data from the TARGIT trial. The costs per QALY for WBI 3D-CRT, APBI IMRT, APBI SL, APBI ML, and APBI I compared with IORT were $47,990-$60,002; $17,335- $29,347; $49,019-$61,031; $108,162-$120,173; and $36,129-$48,141, respectively, based on data from the ELIOT trial. These results are consistent with APBI and WBI being cost-effective compared with IORT. Conclusion Based on cost-minimization analyses, IORT represents a potential cost savings in the management of early-stage breast cancer. However, absolute reimbursement is misleading, because when additional medical and nonmedical costs associated with IORT are factored in, WBI and APBI represent cost-effective modalities based on cost-per-QALY analyses. They remain the standard of care.

Original languageEnglish
Pages (from-to)141-146
Number of pages6
JournalClinical breast cancer
Volume14
Issue number2
DOIs
StatePublished - Apr 2014

Keywords

  • Accelerated partial-breast irradiation
  • Breast conservation therapy
  • Cost efficacy
  • Intraoperative radiation
  • Whole breast irradiation

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    Shah, C., Badiyan, S., Khwaja, S., Shah, H., Chitalia, A., Nanavati, A., Kundu, N., Vaka, V., Lanni, T. B., & Vicini, F. A. (2014). Evaluating radiotherapy options in breast cancer: Does intraoperative radiotherapy represent the most cost-efficacious option? Clinical breast cancer, 14(2), 141-146. https://doi.org/10.1016/j.clbc.2013.10.005