Cost Minimization Analysis of Hypofractionated Radiotherapy

Abstract

Early-stage breast cancer patients comprise a large proportion of patients treated with radiotherapy in Canada. Proponents have suggested that five-fraction hypofractionated radiotherapy for these patients would result in significant cost savings. An assessment of this argument is thus warranted. The FAST-Forward and UK FAST clinical trials each demonstrated that their respective hypofractionated regimens provided equivalent outcomes compared with standard regimens. Thus, a cost-minimization analysis was performed to quantify the potential savings associated with these regimens, which were designated as FAST-Forward 1 (26 Gy/5 fractions/1 week) and FAST-Forward 2 (27 Gy/5 fractions/1 week), and UK FAST 1 (28.5 Gy/5 fractions/5 weeks) and UK FAST 2 (30 Gy/5 fractions/5 weeks). A standard regimen of 42.5 Gy/16 fractions/5 weeks was also included. A comprehensive model of radiotherapy costs for a Canadian cancer centre was created. Time, labour costs, and capital costs were calculated for each regimen and applied using established measures. The total costs per patient for the FAST-Forward trials were $851.77 for FAST-Forward 1 and $874.77 for FAST-Forward 2, providing a total savings of $487.99 and $464.99, respectively. Similarly, the total costs per patient for the FAST trials were $979.75 for UK FAST 1 and $1017.70 for UK FAST 2, providing savings of $360.01 and $322.06, respectively. Following the FAST-Forward 1 regimen results in the greatest reduction of infrastructure and human resources costs at 36.42% compared with the standard. Sensitivity analysis shows a maximum per-patient costs savings ranging from $474.60 to $508.53 for the FAST-Forward 1 trial, which translates to an annual savings of $174,700/year locally and $2.06 million/year province-wide, based on a moderate-to-large size department workload. Compared with a standard radiotherapy regimen, all FAST-Forward and UK FAST hypofractionated regimens provide cost savings for the treatment of early-stage breast cancer. The cost savings associated with each of these equivalent regimens can be directly calculated; activities in this model can easily be adjusted to account for cost variations, allowing other centres to calculate cost impacts specific to their own centres.

Cost analysis of three-dimensional radiation therapy versus intensitymodulated chemoradiotherapy for locally advanced cervical cancer in Peruvian citizens

“…This is the first Latin American study that analyses the costs separated by clinical stage, comparing irradiation techniques. Unlike other studies that are based on annual projections by incidence [ 27 ], and others that only focus on the cost of human resources and infrastructure [ 28 ], due to the nature of the study it has aimed to determine, in detail, both direct and indirect costs, not overlooking micro costs [ 29 , 30 ].…”

Change in the use of fractionation in radiotherapy used for early breast cancer at the start of the COVID-19 pandemic: A population-based cohort study of older women in England and Wales

“…Outputs from the COVID-19 radiotherapy initiative should provide more comprehensive findings on the full impact of changes in radiotherapy on subsequent patient outcomes [34]. Additionally, it would be valuable to examine the considerable financial impact of a move to five-fraction over a week regimens, as has been noted in several publications [14,35,36].…”

Hypofractionated Radiotherapy in Gynecologic Malignancies—A Peek into the Upcoming Evidence

“…The hypofractionation of lengthy radiotherapy courses, where the equivalent radiation dose is delivered in fewer fractions, has several implications for patients and the healthcare system, including decreased resource utilization with fewer human resources and less radiotherapy machine time needed, increased patient throughput and less cost and time for patients [41][42][43]. In addition, hypofractionated RT can address the challenge of nonuniversal RT access and provide comprehensive cancer care, resulting in better quality of life and cancer survival [40,[44][45][46].…”

“…Hypofractionated radiotherapy has several potential advantages over conventional fractionation, including (1) decreasing resource utilization and the cost to the healthcare system [42,44,47]. Hypofractionation reduces the overall treatment machine utilization time, allowing healthcare facilities to treat more patients using similar machine resources [23,42].…”