Chirag Shah1, Shahed Badiyan2, Shariq Khwaja2, Hardeepak Shah3, Ami Chitalia4, Anish Nanavati4, Neilendu Kundu5, Vikram Vaka6, Thomas B Lanni7, Frank A Vicini8. 1. Department of Radiation Oncology, Summa Health System, Akron, OH. Electronic address: csshah27@hotmail.com. 2. Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri. 3. Department of Family Medicine, Cleveland Clinic Foundation, Cleveland, OH. 4. Department of Oncology, Georgetown University School of Medicine, Washington, DC. 5. Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH. 6. Department of Psychiatry, University of Florida, Gainesville, FL. 7. Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI. 8. Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, MI.
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.
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.
Authors: Chirag Shah; Martin Keisch; Atif Khan; Douglas Arthur; David Wazer; Frank Vicini Journal: Ann Surg Oncol Date: 2021-01-13 Impact factor: 5.344
Authors: Taryn E Hassinger; Timothy N Showalter; Anneke T Schroen; David R Brenin; Adam C Berger; Bruce Libby; Shayna L Showalter Journal: J Med Imaging Radiat Oncol Date: 2018-08-13 Impact factor: 1.735