Whole breast irradiation vs. APBI using multicatheter brachytherapy in early breast cancer – simulation of treatment costs based on phase 3 trial data

Abstract

PurposeA recent large phase 3 trial demonstrated that the efficacy of accelerated partial-breast irradiation (APBI) in the treatment of early breast cancer is non-inferior to that of whole breast irradiation (WBI) commonly used in this indication. The aim of this study was to compare the costs of treatment with APBI and WBI in a population of patients after conserving surgery for early breast cancer, and to verify if the use of APBI can result in direct savings of a public payer.Material and methodsThe hereby presented cost analysis was based on the results of GEC-ESTRO trial. Expenditures for identified cost centers were estimated on the basis of reimbursement data for the public payer. After determining the average cost of early breast cancer treatment with APBI and WBI over a 5-year period, the variance in this parameter resulting from fluctuations in the price per single procedure was examined on univariate sensitivity analysis. Then, incremental cost-effectiveness ratio (ICER) was calculated to verify the cost against clinical outcome. Finally, a simulation of public payer’s expenditures for the treatment of early breast cancer with APBI and WBI in 2013 and 2025 has been conducted.ResultsThe average cost of treatment with APBI is lower than for WBI, even assuming a potential increase in the unit price of the former procedure. There was no additional health benefit of WBI and the calculation of cost-effectiveness was based on the absolute difference in overall local control rate. However, this difference (0.92% vs. 1.44%) was fairly minimal and was not identified as statistically significant during 5 years.ConclusionsThe use of APBI as an alternative to WBI in the treatment of early breast cancer would substantially reduce healthcare expenditures in both 2013 and 2025, even assuming an increase in the price per single APBI procedure.

Accelerated partial breast irradiation in a single 18 Gy fraction with high-dose-rate brachytherapy: preliminary results

“…Furthermore, a cost-effectiveness analysis comparing APBI in a single fraction versus WBI or even APBI in several fractions could be performed. In fact, in a cost-effectiveness analysis of Harat et al ., a greater cost-effectiveness was found for APBI [ 36 ].…”

Should molecular subtype be recommended as one of the selection criteria for accelerated partial breast irradiation? Preliminary results from an Asian cohort

“…Cost effectiveness of MIB-APBI technique was shown in a study by Harat et al . [ 2 ]. This study has analyzed average cost of treatment and incremental cost-effectiveness ratio of MIB-APBI compared to WBI in early breast cancer patients over a 5-year period, based on the results of GEC-ESTRO trial.…”

“…The 5-year local control, disease-free survival, and overall survival were similar in the two arms, along with lesser rate of late normal tissue toxicity with APBI [ 1 ]. Cost simulation based on the result of this study has shown that APBI is a cost-effective alternative to WBI [ 2 ]. Satisfaction with the cosmetic outcome and quality of life scores are also higher with MIB-APBI compared to WBI [ 3 ].…”

Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques

“…Currently, interstitial and intracavitary BT in breast cancer is used in the context of APBI after lumpectomy for a highly select group of patients as an alternative to whole breast irradiation (WBI). Despite randomized trials demonstrating equivalent local control, 112,113 less time investment for the patient, and lower cost, 114 APBI BT is not as commonly used as WBI. Reasons include the technical skill and training required on the part of the physician but also patient exclusion because of the anatomic location of the lumpectomy cavity, leading to the inability to meet dose constraints for OARs.…”

“…The literature for conventional HDR-BT reports fairly low rates of chest wall pain and rib fractures (w21.3% and 1.8%, respectively), likely as a result of these guidelines. [112][113][114][115][117][118][119] The reduced dose to these structures with IMBT suggests the possibility of reducing these margins and therefore increasing the patient population for whom APBI may be a viable option.…”