Department of Public Health Sciences, The University of Chicago, Chicago, Illinois.
Department of Public Health Sciences, The University of Chicago, Chicago, Illinois.
Int J Radiat Oncol Biol Phys. 2022 Mar 1;112(3):654-662. doi: 10.1016/j.ijrobp.2021.10.005. Epub 2021 Oct 9.
Rising cancer care expenditures and technological advancement of shorter radiation therapy regimens have drawn significant attention to the use of hypofractionated radiation therapy in clinical care. We examine the costs of hypofractionated whole breast irradiation (HF-WBI) compared with conventional whole breast irradiation (CF-WBI) in the United States and investigate the influences of patient characteristics and commercial insurance on HF-WBI use.
In a retrospective study using private employer-sponsored insurance claims, a pooled cross-sectional evaluation of radiation therapy in patients with commercial insurance was performed from 2008 to 2017. The study population included female patients with early-stage breast cancer treated with lumpectomy and whole breast irradiation.
A total of 15,869 women received HF-WBI, and 59,328 received CF-WBI. HF-WBI use increased from 2008 to 2017. Community-level factors such as a higher proportion of college graduates and greater mixed racial composition were associated with increased HF-WBI use. Mean insurer-paid radiation therapy expenditures were significantly lower for HF-WBI versus CF-WBI (adjusted difference, $6375; 95% confidence interval, $6147-$6603). Mean patient out-of-pocket expenditure for HF-WBI was $139 less than that for CF-WBI. Geographic variation existed across the United States in HF-WBI use (range, 9.6%-36.2%), with no consistent relationship between HF-WBI use and corresponding average cost differences between HF-WBI and CF-WBI.
If trends continue, HF-WBI will soon become the dominant form of radiation treatment in the United States. Although HF-WBI represents significant savings to the health care system and individual patients, no evidence indicated that a financial disincentive had slowed adoption of HF-WBI. Therefore, multilevel approaches, including individuals, the community, and health policy, should be used to promote cost-effective cancer care. Innovations to policies on cost-effective radiation therapy treatment might consider non-financial incentives to promote HF-WBI use.
不断增长的癌症治疗支出和更短的放射治疗方案的技术进步，使人们对临床治疗中应用缩短分割放射治疗（hypofractionated radiation therapy）给予了极大关注。本研究在美国范围内比较了缩短分割全乳照射（hypofractionated whole breast irradiation，HF-WBI）与常规全乳照射（conventional whole breast irradiation，CF-WBI）的成本，并探讨了患者特征和商业保险对 HF-WBI 使用的影响。
本研究采用回顾性研究方法，利用私人雇主赞助的保险理赔数据，对 2008 年至 2017 年接受商业保险的放射治疗患者进行了汇总的横截面评估。研究人群包括接受保乳术和全乳照射的早期乳腺癌女性患者。
共有 15869 例女性接受 HF-WBI，59328 例接受 CF-WBI。HF-WBI 的使用率从 2008 年到 2017 年逐渐增加。社区层面的因素，如更高比例的大学毕业生和更多的混合种族构成，与 HF-WBI 使用率的增加有关。与 CF-WBI 相比，HF-WBI 的保险公司支付的放疗费用平均低 6375 美元（95%置信区间：6147 美元6603 美元），HF-WBI 的患者自付费用比 CF-WBI 低 139 美元。HF-WBI 的使用率在美国各地存在差异（范围：9.6%36.2%），HF-WBI 使用率与 HF-WBI 和 CF-WBI 之间的平均成本差异之间没有一致的关系。
如果这种趋势持续下去，HF-WBI 将很快成为美国主要的放疗形式。尽管 HF-WBI 为医疗保健系统和个体患者带来了显著的节省，但没有证据表明经济上的不利因素减缓了 HF-WBI 的采用。因此，应采用包括个人、社区和卫生政策在内的多层次方法来促进具有成本效益的癌症护理。针对具有成本效益的放疗治疗政策的创新，可以考虑非经济激励措施来促进 HF-WBI 的使用。
