Lester-Coll Nataniel H, Rutter Charles E, Evans Suzanne B
Department of Therapeutic Radiology, Yale School of Medicine, United States.
Department of Therapeutic Radiology, Yale School of Medicine, United States.
Radiother Oncol. 2016 Apr;119(1):52-6. doi: 10.1016/j.radonc.2016.01.026. Epub 2016 Feb 8.
Breast radiotherapy (RT) for elderly women with estrogen receptor positive early stage breast cancer (ER+ESBC) improves local recurrence (LR) rates without benefitting overall survival. Breast boost is a common practice, although the absolute benefit decreases with age. Consequently, an analysis of its cost-effectiveness in the elderly ESBC populations is warranted.
A Markov model was used to compare cost-effectiveness of RT with or without a boost in elderly ER+ESBC patients. The ten-year probability of LR with boost was derived from the CALGB 9343 trial and adjusted by the hazard ratio for LR from boost radiotherapy trial data, yielding the LR rate without boost. Remaining parameters were estimated using published data.
Boost RT was associated with an increase in mean cost ($7139 vs $6193) and effectiveness (5.66 vs 5.64 quality adjusted life years; QALYs) relative to no boost. The incremental cost-effectiveness ratio (ICER) for boost was $55,903 per QALY. On one-way sensitivity analysis, boost remained cost-effective if the hazard ratio of LR with boost was <0.67.
Boost RT for ER+ESBC patients was cost-effective over a wide range of assumptions and inputs over commonly accepted willingness-to pay-thresholds, but particularly in women at higher risk for LR.
对于雌激素受体阳性早期乳腺癌（ER+ESBC）老年女性，乳腺放疗（RT）可提高局部复发（LR）率，但对总生存期无益处。乳腺追加放疗是一种常见做法，尽管其绝对获益随年龄增长而降低。因此，有必要分析其在老年ER+ESBC人群中的成本效益。
采用马尔可夫模型比较老年ER+ESBC患者接受或不接受追加放疗的成本效益。追加放疗后10年LR概率源自CALGB 9343试验，并根据追加放疗试验数据中LR的风险比进行调整，得出未追加放疗时的LR率。其余参数使用已发表数据进行估计。
相对于不进行追加放疗，追加放疗与平均成本增加（7139美元对6193美元）和有效性提高（5.66个质量调整生命年对5.64个质量调整生命年；QALYs）相关。追加放疗的增量成本效益比（ICER）为每QALY 55,903美元。在单向敏感性分析中，如果追加放疗时LR的风险比<0.67，则追加放疗仍具有成本效益。
对于ER+ESBC患者，在广泛的假设和投入范围内，相对于普遍接受的支付意愿阈值，追加放疗具有成本效益，尤其是在LR风险较高的女性中。
