Shah Chirag, Badiyan Shahed, Khwaja Shariq, Shah Hardeepak, Chitalia Ami, Nanavati Anish, Kundu Neilendu, Vaka Vikram, Lanni Thomas B, Vicini Frank A
Department of Radiation Oncology, Summa Health System, Akron, OH.
Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
Clin Breast Cancer. 2014 Apr;14(2):141-6. doi: 10.1016/j.clbc.2013.10.005. Epub 2013 Oct 25.
This study analyzed the cost-efficacy of intraoperative radiation therapy (IORT) compared with whole-breast irradiation (WBI) and accelerated partial-breast irradiation (APBI) for early-stage breast cancer.
Data for this analysis came from 2 phase III trials: the TARGIT (Targeted Intraoperative Radiotherapy) trial and the ELIOT (Electron Intraoperative Radiotherapy) trial. Cost analyses included a cost-minimization analysis and an incremental cost-effectiveness ratio analysis including a quality-adjusted life-year (QALY) analysis. Cost analyses were performed comparing IORT with WBI delivered using 3-dimensional conformal radiotherapy (3D-CRT), APBI 3D-CRT, APBI delivered with intensity-modulated radiotherapy (IMRT), APBI single-lumen (SL), APBI multilumen (ML), and APBI interstitial (I).
Per 1000 patients treated, the cost savings with IORT were $3.6-$4.3 million, $1.6-$2.4 million, $3.6-$4.4 million, $7.5-$8.2 million, and $2.8-$3.6 million compared with WBI 3D-CRT, APBI IMRT, APBI SL, APBI ML, and APBI I, respectively, with a cost decrement of $1.6-$2.4 million compared with APBI 3D-CRT based on data from the TARGIT trial. The costs per QALY for WBI 3D-CRT, APBI IMRT, APBI SL, APBI ML, and APBI I compared with IORT were $47,990-$60,002; $17,335-$29,347; $49,019-$61,031; $108,162-$120,173; and $36,129-$48,141, respectively, based on data from the ELIOT trial. These results are consistent with APBI and WBI being cost-effective compared with IORT.
Based on cost-minimization analyses, IORT represents a potential cost savings in the management of early-stage breast cancer. However, absolute reimbursement is misleading, because when additional medical and nonmedical costs associated with IORT are factored in, WBI and APBI represent cost-effective modalities based on cost-per-QALY analyses. They remain the standard of care.
本研究分析了术中放疗（IORT）与全乳照射（WBI）及加速部分乳腺照射（APBI）治疗早期乳腺癌的成本效益。
本分析的数据来自两项III期试验：TARGIT（靶向术中放疗）试验和ELIOT（电子术中放疗）试验。成本分析包括成本最小化分析和增量成本效益比分析，后者包括质量调整生命年（QALY）分析。进行成本分析时，将IORT与采用三维适形放疗（3D-CRT）的WBI、APBI 3D-CRT、采用调强放疗（IMRT）的APBI、单腔APBI（SL）、多腔APBI（ML）以及间质APBI（I）进行比较。
每治疗1000例患者，与WBI 3D-CRT、APBI IMRT、APBI SL、APBI ML和APBI I相比，IORT节省的成本分别为360万至430万美元、160万至240万美元、360万至440万美元、750万至820万美元以及280万至360万美元；根据TARGIT试验的数据，与APBI 3D-CRT相比，成本降低了160万至240万美元。根据ELIOT试验的数据，与IORT相比，WBI 3D-CRT、APBI IMRT、APBI SL、APBI ML和APBI I每QALY的成本分别为47,990至60,002美元、17,335至29,347美元、49,019至61,031美元、108,162至120,173美元以及36,129至48,141美元。这些结果与APBI和WBI与IORT相比具有成本效益一致。
基于成本最小化分析，IORT在早期乳腺癌管理中可能节省成本。然而，绝对报销金额具有误导性，因为当考虑与IORT相关的额外医疗和非医疗成本时，根据每QALY成本分析，WBI和APBI是具有成本效益的方式。它们仍然是护理标准。
