Cost and Cost-Effectiveness of Image Guided Partial Breast Irradiation in Comparison to Hypofractionated Whole Breast Irradiation
Menée aux Etats-Unis à l'aide d'une méthode de micro-costing, cette étude évalue, par rapport à une radiothérapie hypofractionnée de l'ensemble du sein, les coûts et le rapport coût-efficacité d'une irradiation mammaire partielle guidée par l'imagerie
Purpose : Hypofractionated whole breast irradiation (HWBI) and accelerated partial breast irradiation (APBI) represent two adjuvant radiation therapy options following breast conserving surgery. We performed a cost and cost-effectiveness analysis of an external beam image guided APBI technique compared to HWBI. Methods : HWBI was defined as 40 Gy/15 fractions to the whole breast with or without a 10 Gy/5 fraction boost. APBI was 30 Gy/5 fractions per Livi et al and was evaluated as both IMRT and SBRT. The decision analytic model measured effectiveness in quality-adjusted life years (QALYs). Micro-costing was conducted in order to estimate the true cost of the different treatment regimens and incremental cost-effectiveness analysis was performed. Results : Based on micro-costing, the cost of HWBI was $4,551 with boost and $3,666 without boost, compared to $2,966 for APBI. Including indirect costs, HWBI with boost cost $6,160, HWBI without boost cost $4,940 and APBI cost $3,569. Cost savings for APBI compared to HWBI with and without boost was $1,585/$700 based on direct costs and $2,591/$1,371 including indirect costs. APBI was also more effective, at .2300 QALYs compared to .2289 for HWBI with or without boost. Thus, APBI was both less costly and more effective. Basing cost on Medicare reimbursement (IMRT) leads to APBI again dominating HWBI, but basing cost for APBI on reimbursement billed as SBRT leads to HWBI being far more cost-effective. Conclusions : Image-guided partial breast irradiation is less costly to deliver and has slightly improved efficacy compared to hypofractionated WBI, with or without a boost. IMRT APBI should be considered a standard of care option in appropriately selected patients based on efficacy and value.