Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
Int J Radiat Oncol Biol Phys. 2019 Feb 1;103(2):397-402. doi: 10.1016/j.ijrobp.2018.09.021. Epub 2018 Sep 22.
Hypofractionated whole breast irradiation (HWBI) and accelerated partial breast irradiation (APBI) represent two adjuvant radiation therapy options after breast-conserving surgery. We performed a cost and cost-effectiveness analysis of an external beam image guided APBI technique compared with HWBI.
HWBI was defined as 40 Gy in 15 fractions to the whole breast with or without a 10-Gy/5-fraction boost. APBI was 30 Gy in 5 fractions per Livi et al and was evaluated as both intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy. The decision analytical model measured effectiveness in quality-adjusted life years. Micro-costing was conducted to estimate the true cost of the different treatment regimens, and incremental cost-effectiveness analysis was performed.
Based on micro-costing, the cost of HWBI was $4551 with boost and $3666 without boost, compared with $2966 for APBI. Including indirect costs, HWBI with boost cost $6160, HWBI without boost cost $4940, and APBI cost $3569. Cost savings for APBI compared with HWBI with and without boost was $1585 and $700 based on direct costs and $2591 and $1371 including indirect costs. APBI was also more effective, at 0.2300 quality-adjusted life years compared with 0.2289 for HWBI with or without boost. Thus, APBI was both less costly and more effective. Basing cost on Medicare reimbursement (IMRT) leads to APBI again dominating HWBI, but basing cost for APBI on reimbursement billed as stereotactic body radiation therapy leads to HWBI being far more cost-effective.
Image guided partial breast irradiation is less costly to deliver and has slightly improved efficacy compared with HWBI, with or without a boost. IMRT APBI should be considered a standard-of-care option in appropriately selected patients based on efficacy and value.
在保乳手术后，采用部分乳房照射（APBI）和全乳房加速照射（HWBI）是两种辅助放疗选择。我们比较了外照射图像引导 APBI 技术与 HWBI 的成本和成本效益分析。
HWBI 定义为全乳房 40Gy/15 次分割，可加用 10Gy/5 次分割推量。APBI 为 Livi 等提出的 30Gy/5 次分割，评价方式为调强放疗（IMRT）和立体定向体部放疗。决策分析模型以质量调整生命年来衡量有效性。微观成本核算用于估计不同治疗方案的真实成本，并进行增量成本效益分析。
基于微观成本，HWBI 加量和不加量的成本分别为 4551 美元和 3666 美元，而 APBI 的成本为 2966 美元。包括间接成本在内，HWBI 加量的成本为 6160 美元，HWBI 不加量的成本为 4940 美元，APBI 的成本为 3569 美元。与 HWBI 加量和不加量相比，APBI 可节省 1585 美元和 700 美元（直接成本）和 2591 美元和 1371 美元（包括间接成本）。APBI 也更有效，质量调整生命年为 0.2300，HWBI 加量和不加量分别为 0.2289。因此，APBI 不仅成本更低，而且效果更好。基于医疗保险报销（IMRT）的成本使 APBI 再次优于 HWBI，但基于立体定向体部放疗计费的 APBI 成本使 HWBI 更具成本效益。
与 HWBI 加量和不加量相比，图像引导部分乳房照射的实施成本更低，且疗效略有提高。基于疗效和价值，在适当选择的患者中，调强放疗 APBI 应被视为标准治疗选择。
