Breast Cancer Research and Treatment

, Volume 136, Issue 2, pp 547–557 | Cite as

Economic evaluation of radiotherapy for early breast cancer after breast-conserving surgery in a health resource-limited setting

  • Yongrui Bai
  • Ming Ye
  • Hongbin Cao
  • Xiumei Ma
  • Yuejuan Xu
  • Bin Wu


The primary objective was to assess the cost-effectiveness, from the Chinese societal perspective, of additional radiotherapy for women with early breast cancer after breast-conserving surgery (BCS). The Markov model was constructed to simulate women’s transitions across various health states based on the clinical course of breast cancer (no recurrence, local or distant recurrence, and death) and treatment strategy (radiotherapy vs. no-radiotherapy). The clinical and utility data were estimated from published studies. Costs were estimated from the perspective of Chinese society. Quality-adjusted life-years (QALYs) and incremental cost-effective ratios (ICERs) were determined. Probabilistic and one-way sensitivity analyses were performed. The addition of radiotherapy following BCS was associated with improved overall survival (22.20 vs. 19.51 years) and QALYs (13.25 vs. 11.75) and reduced lifetime costs ($24,518.9 vs. $25,147.0). The ICER of radiotherapy vs. no-radiotherapy was −$420.56/QALY gained. Sensitivity, subgroup and scenario analyses indicated that these results were robust against plausible assumptions and variations. In health resource-limited settings, the addition of radiotherapy is a very cost-effective strategy in comparison to no-radiotherapy in women with early breast cancer.


Early breast cancer Cost-effectiveness Markov model Radiotherapy 



This study was supported by a grant from Shanghai Jiaotong University School of Medicine (no. 2011.18).

Conflict of interest

The authors declared no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Yongrui Bai
    • 1
  • Ming Ye
    • 2
  • Hongbin Cao
    • 1
  • Xiumei Ma
    • 1
  • Yuejuan Xu
    • 3
  • Bin Wu
    • 4
  1. 1.Department of RadiotherapyRenji Hospital, Affiliated with the School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
  2. 2.Department of Clinical OncologyRenji Hospital, Affiliated with the School of Medicine, Shanghai Jiaotong UniversityShanghaiChina
  3. 3.Department of Clinical OncologyThe Second Hospital of Nanjing, Affiliated with the Medical School of South East UniversityNanjingChina
  4. 4.Clinical Outcomes and Economics Group, Department of PharmacyRenji Hospital, Affiliated with the School of Medicine, Shanghai Jiaotong UniversityShanghaiChina

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