Cost-effectiveness of 5 fraction and partial breast radiotherapy for early breast cancer in the UK: model-based multi-trial analysis

Abstract

Purpose We estimated the cost-effectiveness of 4 radiotherapy modalities to treat early breast cancer in the UK. In a subgroup of patients eligible for all modalities, we compared whole-breast (WB) and partial breast (PB) radiotherapy delivered in either 15 (WB15F, PB15F) or 5 fractions (WB5F, PB5F). In a subgroup ineligible for PB radiotherapy, we compared WB15F to WB5F. Methods We developed a Markov cohort model to simulate lifetime healthcare costs and quality-adjusted life years (QALYs) for each modality. This was informed by the clinical analysis of two non-inferiority trials (FAST Forward and IMPORT LOW) and supplemented with external literature. The primary analysis assumed that radiotherapy modality influences health only through its impact on locoregional recurrence and radiotherapy-related adverse events. Results In the primary analysis, PB5F had the least cost and greatest expected QALYs. WB5F had the least cost and the greatest expected QALYs in those only eligible for WB radiotherapy. Applying a cost-effectiveness threshold of £15,000/QALY, there was a 62% chance that PB5F was the cost-effective alternative in the PB eligible group, and there was a 100% chance that WB5F was cost-effective in the subgroup ineligible for PB radiotherapy. Conclusions Hypofractionation to 5 fractions and partial breast radiotherapy modalities offer potentially important benefits to the UK health system.

Economic burden of breast cancer: a case of Southern Iran

“…Given that many of the patients in this study needed to have multiple radiotherapy sessions, the cost of this part of direct medical costs was higher than others. Glynn and colleagues in their study conducted in the UK (2023) stated that although the cost of radiotherapy is very high, radiotherapy after primary surgery for breast cancer patients reduced the risk of recurrence in half for the next 10 years [ 38 ]. The results of the present study are in line with the findings of Lao et al (2022) in New Zealand [ 39 ], Ferrier et al (2020) in France [ 40 ], Hu et al (2020) [ 41 ], and Sagar et al (2017) [ 42 ] in the US, Capri et al (2017) in Italy [ 43 ], Giordano et al (2016) in the US [ 44 ], Ivanauskien et al (2015) in Lithuania [ 45 ], and Bahmei et al (2015) [ 46 ] and Yavari (2013) in Iran [ 47 ].…”

Case Report: Intraoperative radiotherapy as the new standard of care for breast cancer patients with disabling health conditions or impairments

“…Radiotherapy department costs are largely fixed and dependent on departmental throughput, therefore the new 5 fraction regimen reduces costs per patient but may not significantly reduce costs if units stay busy. An updated cost benefit analysis comparing TARGIT-IORT to the current standard of care must be elucidated ( 37 , 38 ).…”

Hypofractionation: The standard for external beam breast irradiation

“…Glynn et al formally evaluated IMPORT LOW and FAST-Forward for costs and health consequences associated with PBI and 5-fraction hypofractionation in a UK population [ 42 ]. Health impacts were captured using QALYs.…”