Annals of Surgical Oncology

, Volume 20, Issue 9, pp 2873–2880 | Cite as

Cost-Effectiveness Analysis of Intraoperative Radiation Therapy for Early-Stage Breast Cancer

  • Michael D. AlvaradoEmail author
  • Aron J. Mohan
  • Laura J. Esserman
  • Catherine C. Park
  • Brittany L. Harrison
  • Rebecca J. Howe
  • Cristina Thorsen
  • Elissa M. Ozanne
Breast Oncology



Shortened courses of radiation therapy have been shown to be similarly effective to whole-breast external-beam radiation therapy (WB-EBRT) in terms of local control. We sought to analyze, from a societal perspective, the cost-effectiveness of two radiation strategies for early-stage invasive breast cancer: single-dose intraoperative radiation therapy (IORT) and the standard 6-week course of WB-EBRT.


We developed a Markov decision-analytic model to evaluate these treatment strategies in terms of life expectancy, quality-adjusted life years (QALYs), costs, and the incremental cost-effectiveness ratio over 10 years.


IORT single-dose intraoperative radiation therapy was the dominant, more cost-effective strategy, providing greater quality-adjusted life years at a decreased cost compared with 6-week WB-EBRT. The model was sensitive to health state utilities and recurrence rates, but not costs. IORT was either the preferred or dominant strategy across all sensitivity analyses. The two-way sensitivity analyses demonstrate the need to accurately determine utility values for the two forms of radiation treatment and to avoid indiscriminate use of IORT.


With less cost and greater QALYs than WB-EBRT, IORT is the more valuable strategy. IORT offers a unique example of new technology that is less costly than the current standard of care option but offers similar efficacy. Even when considering the capital investment for the equipment ($425 K, low when compared with the investments required for robotic surgery or high-dose-rate brachytherapy), which could be recouped after 3–4 years conservatively, these results support IORT as a change in practice for treating early-stage invasive breast cancer.


Local Recurrence Rate Health State Utility Medicare Reimbursement Reimbursement Code Salvage Mastectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Michael D. Alvarado, MD, and Laura J. Esserman, MD, MBA served as members of the International Steering Committee for the TARGIT-A trial. The study has previously been presented, in part, at the St. Gallen Breast Cancer Conference, March 16–19 2011, St. Gallen, Switzerland, and the American Society of Clinical Oncology, June 3–7, 2011, Chicago, IL.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Michael D. Alvarado
    • 1
    Email author
  • Aron J. Mohan
    • 2
  • Laura J. Esserman
    • 1
  • Catherine C. Park
    • 3
  • Brittany L. Harrison
    • 1
  • Rebecca J. Howe
    • 1
    • 4
  • Cristina Thorsen
    • 1
  • Elissa M. Ozanne
    • 1
    • 4
  1. 1.Department of SurgeryUCSF Comprehensive Cancer CenterSan FranciscoUSA
  2. 2.Warren Alpert Medical SchoolBrown UniversityProvidenceUSA
  3. 3.Department of Radiation OncologyUniversity of CaliforniaSan FranciscoUSA
  4. 4.Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoUSA

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