Harat Aleksandra, Harat Maciej, Makarewicz Roman
Department of Public Health, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
Radiotherapy Department, Oncology Center, Bydgoszcz.
J Contemp Brachytherapy. 2016 Dec;8(6):505-511. doi: 10.5114/jcb.2016.64919. Epub 2016 Dec 30.
A recent large phase 3 trial demonstrated that the efficacy of accelerated partial-breast irradiation (APBI) in the treatment of early breast cancer is non-inferior to that of whole breast irradiation (WBI) commonly used in this indication. The aim of this study was to compare the costs of treatment with APBI and WBI in a population of patients after conserving surgery for early breast cancer, and to verify if the use of APBI can result in direct savings of a public payer.
The hereby presented cost analysis was based on the results of GEC-ESTRO trial. Expenditures for identified cost centers were estimated on the basis of reimbursement data for the public payer. After determining the average cost of early breast cancer treatment with APBI and WBI over a 5-year period, the variance in this parameter resulting from fluctuations in the price per single procedure was examined on univariate sensitivity analysis. Then, incremental cost-effectiveness ratio (ICER) was calculated to verify the cost against clinical outcome. Finally, a simulation of public payer's expenditures for the treatment of early breast cancer with APBI and WBI in 2013 and 2025 has been conducted.
The average cost of treatment with APBI is lower than for WBI, even assuming a potential increase in the unit price of the former procedure. There was no additional health benefit of WBI and the calculation of cost-effectiveness was based on the absolute difference in overall local control rate. However, this difference (0.92% vs. 1.44%) was fairly minimal and was not identified as statistically significant during 5 years.
The use of APBI as an alternative to WBI in the treatment of early breast cancer would substantially reduce healthcare expenditures in both 2013 and 2025, even assuming an increase in the price per single APBI procedure.
最近一项大型3期试验表明，加速部分乳腺照射（APBI）治疗早期乳腺癌的疗效不劣于该适应症中常用的全乳照射（WBI）。本研究的目的是比较早期乳腺癌保乳手术后患者群体中APBI和WBI的治疗成本，并验证使用APBI是否能直接节省公共支付方的费用。
本成本分析基于GEC-ESTRO试验的结果。根据公共支付方的报销数据估算已确定成本中心的支出。在确定APBI和WBI治疗早期乳腺癌5年期间的平均成本后，通过单因素敏感性分析检查因单次手术价格波动导致的该参数变化。然后，计算增量成本效益比（ICER）以验证成本与临床结果的关系。最后，对2013年和2025年公共支付方使用APBI和WBI治疗早期乳腺癌的支出进行了模拟。
即使假设APBI单次手术单价可能上涨，其平均治疗成本仍低于WBI。WBI没有额外的健康益处，成本效益计算基于总体局部控制率的绝对差异。然而，这种差异（0.92%对1.44%）相当小，在5年期间未被确定为具有统计学意义。
即使假设单次APBI手术价格上涨，在治疗早期乳腺癌时使用APBI替代WBI仍将在2013年和2025年大幅降低医疗保健支出。
