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American Journal of Clinical Oncology:
doi: 10.1097/COC.0b013e318271b16d
Original Articles: Breast

Cost-Effectiveness of 3-Dimensional Conformal Radiotherapy and Applicator-based Brachytherapy in the Delivery of Accelerated Partial Breast Irradiation

Shah, Chirag MD*; Lanni, Thomas MBA; Wilkinson, John Ben MD; Jawad, Maha MD; Wobb, Jessica MD; Berry, Sameer BS; Wallace, Michelle RN; Chen, Peter MD; Grills, Inga S. MD

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Purpose: To compare reimbursement and cost efficacy between accelerated partial breast irradiation (APBI) techniques.

Materials/Methods: Four hundred fifty-three patients were treated with APBI using either 3-dimensional conformal radiotherapy (3D-CRT, n=207) or balloon-based brachytherapy (BB) [single-lumen (SL, n=161) and multilumen (ML, n=85)] between March 2000 and October 2011. To evaluate cost-effectiveness, reimbursement by treatment technique was calculated based on 2011 Medicare schedules. Facility costs were generated by technique based on ICD-9 codes. Incremental cost effectiveness ratios (ICER), which compares cost with clinical outcomes, were calculated according to the difference in reimbursement to the criteria being evaluated.

Results: With a median follow-up of 3.6 years, the 5-year rate of local recurrence was 1.9% for all patients (3D-CRT, 0%; BB, 4.1%; P=0.23). When pooled, BB patients had a significant improvement in excellent/good cosmesis (91.6% vs. 80.0%; P=0.03). Rates of combined grade 2 or higher dermatitis, hyper/hypopigmentation, pain, or fibrosis per technique were 62%, 28%, and 34% for 3D-CRT, SL, and ML patients, respectively (P=0.26). The ICER per percent improved cosmesis for SL/ML was $519/$850 based on reimbursement and $301/$643 based on cost compared with 3D-CRT.

Conclusions: On the basis of ICER, brachytherapy for APBI is a cost-effective option with regard to cosmesis and toxicity. This economic analysis suggests the increased cost of applicator-based brachytherapy may be justified in appropriately selected patients.

© 2014 by Lippincott Williams & Wilkins, Inc


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