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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

American Journal of Clinical Oncology: April 2014 - Volume 37 - Issue 2 - p 172–176
doi: 10.1097/COC.0b013e318271b16d
Original Articles: Breast

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.

*Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri

Department of Radiation Oncology, Beaumont Cancer Institute, William Beaumont School of Medicine, Oakland University, Royal Oak, MI

The authors declare no conflicts of interest.

Reprints: Thomas Lanni, MBA, Department of Radiation Oncology, Beaumont Cancer Institute, William Beaumont School of Medicine, Oakland University, 3601 West 13 Mile Road, Royal Oak, MI 48073. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc