Suh W Warren, Pierce Lori J, Vicini Frank A, Hayman James A
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Int J Radiat Oncol Biol Phys. 2005 Jul 1;62(3):790-6. doi: 10.1016/j.ijrobp.2004.10.039.
To assess, if and for whom, there are cost savings associated with alternate breast radiotherapy (RT) techniques when compared with the conventional external beam-based whole-breast RT with a boost (WBRT-B).
Treatment planning and delivery utilization data were modeled for eight different breast RT techniques: (1) WBRT-B: 60 Gy in 30 fractions; (2) WBRT: 50 Gy in 25 fractions; (3) WBRT-accelerated (AC): 42.5 Gy in 16 fractions; (4) WBRT-intensity-modulated RT (IMRT): 60 Gy in 30 fractions; (5) accelerated partial breast irradiation (APBI)-IC, MammoSite: 34 Gy in 10 twice-daily fractions; (6) APBI-IT, HDR interstitial: 34 Gy in 10 twice-daily fractions; (7) APBI three-dimensional conformal RT (3D-CRT): 38.5 Gy in 10 twice-daily fractions; or (8) APBI-IMRT: 38.5 Gy in 10 twice-daily fractions. Costs incurred by payer (i.e., direct medical costs; 2003 Medicare Fee Schedule) and patient (i.e., direct nonmedical costs; time and travel) were estimated. Total societal costs were then calculated for each treatment approach.
Not all efforts to reduce overall treatment time result in total cost savings. The least expensive partial breast-based RT approaches were the external beam techniques (APBI-3D-CRT, APBI-IMRT). Any reduced cost to patients for the HDR brachytherapy-based APBI regimens were overshadowed by substantial increases in cost to payers, resulting in higher total societal costs; the cost of HDR treatment delivery was primarily responsible for the increased direct medical cost. For the whole breast-based RT approaches, treating without a boost (WBRT) or with WBRT-AC reduced total costs. Overall, WBRT-AC was the least costly of all the regimens, in terms of costs to society; APBI approaches, in general, were favored over whole-breast techniques when only considering costs to patients.
Based on societal cost considerations, WBRT-AC appears to be the preferred approach. If one were to pursue a partial-breast RT regimen to minimize patient costs, it would be more advantageous from a societal perspective to pursue external beam-based approaches such as APBI-3D-CRT or APBI-IMRT in lieu of the brachytherapy-based regimens.
评估与传统的基于外照射的全乳放疗加瘤床补量（WBRT-B）相比，替代乳腺放疗（RT）技术是否以及对哪些人能节省成本。
对八种不同的乳腺RT技术进行治疗计划和交付利用数据建模：（1）WBRT-B：30次分割，总剂量60 Gy；（2）WBRT：25次分割，总剂量50 Gy；（3）加速全乳放疗（AC）：16次分割，总剂量42.5 Gy；（4）调强放疗（IMRT）的WBRT：30次分割，总剂量60 Gy；（5）腔内近距离放疗（IC）的加速部分乳腺照射（APBI），MammoSite：每日两次，共10次分割，总剂量34 Gy；（6）高剂量率（HDR）组织间插植放疗（IT）的APBI：每日两次，共10次分割，总剂量34 Gy；（7）三维适形放疗（3D-CRT）的APBI：每日两次，共10次分割，总剂量38.5 Gy；或（8）IMRT的APBI：每日两次，共10次分割，总剂量38.5 Gy。估算了支付方产生的成本（即直接医疗成本；2003年医疗保险费用表）和患者产生的成本（即直接非医疗成本；时间和交通费用）。然后计算每种治疗方法的社会总成本。
并非所有缩短总体治疗时间的努力都能节省总成本。最便宜的基于部分乳腺的RT方法是外照射技术（APBI-3D-CRT、APBI-IMRT）。基于HDR近距离放疗的APBI方案给患者带来的任何成本降低都被支付方成本的大幅增加所抵消，导致社会总成本更高；HDR治疗交付成本是直接医疗成本增加的主要原因。对于基于全乳的RT方法，不进行瘤床补量（WBRT）或采用WBRT-AC可降低总成本。总体而言，就社会成本而言，WBRT-AC是所有方案中成本最低的；一般来说，仅考虑患者成本时，APBI方法比全乳技术更受青睐。
基于社会成本考虑，WBRT-AC似乎是首选方法。如果要采用部分乳腺RT方案以尽量降低患者成本，从社会角度来看，采用基于外照射的方法如APBI-3D-CRT或APBI-IMRT代替基于近距离放疗的方案会更有利。
