Cost-Effectiveness Analysis of Intraoperative Radiation Therapy for Early-Stage Breast Cancer
- 1k Downloads
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.
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.
- 2.Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–16.PubMedCrossRefGoogle Scholar
- 4.Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.PubMedCrossRefGoogle Scholar
- 10.Shepard DS. Cost-effectiveness in health and medicine. 1st ed. New York: Oxford University Press; 1996.Google Scholar
- 16.Christensen CM, Bohmer R, Kenagy J. Will disruptive innovations cure health care? Harv Bus Rev. 2000;78:102–12, 199.Google Scholar
- 18.Alvarado M, Connolly J, Oboite M, Moore D, Park C, Esserman L. Patient preference for choosing intra-operative or external-beam radiotherapy following breast conservation. 7th European breast cancer conference. Barcelona, Spain. Eur J Cancer Suppl. 2010;8:126–7.Google Scholar
- 21.Drummond M, Sculpher M, Torrance G. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2005.Google Scholar
- 22.Cancer IAfRo. Breast cancer incidence and mortality worldwide in 2008 summary. http://globocan.iarc.fr/factsheets/cancers/breast.asp.
- 25.Medicare Physician Fee Schedule (MFS). U.S. Department of Health and Human Services; 2010. http://www.cms.gov/apps/physician-fee-schedule/overview.aspx.
- 26.Outpatient Prospective Payment System (OPPS). U.S. Department of Health and Human Services; 2010.Google Scholar
- 27.Healthcare Common Procedure Coding System (HCPCS). U.S. Department of Health and Human Services; 2011.Google Scholar
- 28.Highlights of Women’s Earnings in 2010. In: Labor USDo, ed, U.S. Bureau of Labor Statistics; 2011.Google Scholar
- 29.CPI Inflation Calculator. U.S. Bureau of Labor Statistics; 2011. http://data.bls.gov/cgi-bin/cpicalc.pl.
- 30.IRS announces 2011 standard mileage rates: internal revenue service; 2010.Google Scholar
- 31.Gasoline and Diesel Fuel Update. U.S. Energy Information Administration; 2011. http://www.eia.gov/oog/info/gdu/gasdiesel.asp.