Cost comparison of radiation treatment options after lumpectomy for breast cancer

Rachel A. Greenup, Melissa Camp, Alphonse G. Taghian, Julliette Buckley, Suzanne B. Coopey, Michele Gadd, Kevin Hughes, Michelle Specht, Barbara L. Smith

Research output: Contribution to journalArticle

Abstract

Background. Radiation therapy (RT) after lumpectomy for breast cancer can be delivered with several different regimens. We evaluated a cost-minimization strategy to select among RT options. Methods. An institutional review board (IRB)-A pproved retrospective review identified a sample of 100 women who underwent lumpectomy for invasive or in situ breast cancer during 2009. Post lumpectomy RT options included: no radiation in women ≥70 years [T1N0, estrogen receptor (ER)+] per Cancer and Leukemia Group B (CALGB) 9343 (no-RT), accelerated external-beam partial-breast irradiation (APBI), and Canadian fractionation (C-RT), as alternatives to standard whole-breast radiation therapy (WBRT). Eligibility for RT regimens was based on published criteria. RT costs were estimated using the 2011 US Medicare Physician Fee Schedule and average Current Procedural Terminology (CPT) codes billed per regimen at our institution. Costs were modeled in a 1,000-patient theoretical cohort. Results. Median patient age was 56.5 years (range 32-93 years). Tumor histology included invasive ductal cancer (78 %), ductal carcinoma in situ (DCIS) (15 %), invasive lobular cancer (6 %), and mixed histology (1 %). Median tumor size was 1 cm (range 0.2-5 cm). Estimated per-patient cost of radiation was US$5,341.81 for APBI, US$9,121.98 for C-RT, and US$13,358.37 for WBRT. When patients received the least expensive radiation regimen for which they were eligible, 14 % received no-RT, 44 % received APBI, 7 % received C-RT, and 35 % defaulted to WBRT. Using a cost-minimization strategy, estimated RT costs were US$7.67 million, versus US$13.36 million had all patients received WBRT, representing cost savings of US$5.69 million per 1,000 patients treated. Conclusions. A cost-minimization strategy results in a 43 % reduction in estimated radiation costs among women undergoing breast conservation.

Original languageEnglish (US)
Pages (from-to)3275-3281
Number of pages7
JournalAnnals of Surgical Oncology
Volume19
Issue number10
DOIs
StatePublished - Oct 2012
Externally publishedYes

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Segmental Mastectomy
Radiotherapy
Radiation
Breast Neoplasms
Costs and Cost Analysis
Breast
Therapeutics
Neoplasms
Histology
Fee Schedules
Current Procedural Terminology
Carcinoma, Intraductal, Noninfiltrating
Cost Savings
Research Ethics Committees
Medicare
Estrogen Receptors

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Greenup, R. A., Camp, M., Taghian, A. G., Buckley, J., Coopey, S. B., Gadd, M., ... Smith, B. L. (2012). Cost comparison of radiation treatment options after lumpectomy for breast cancer. Annals of Surgical Oncology, 19(10), 3275-3281. https://doi.org/10.1245/s10434-012-2546-5

Cost comparison of radiation treatment options after lumpectomy for breast cancer. / Greenup, Rachel A.; Camp, Melissa; Taghian, Alphonse G.; Buckley, Julliette; Coopey, Suzanne B.; Gadd, Michele; Hughes, Kevin; Specht, Michelle; Smith, Barbara L.

In: Annals of Surgical Oncology, Vol. 19, No. 10, 10.2012, p. 3275-3281.

Research output: Contribution to journalArticle

Greenup, RA, Camp, M, Taghian, AG, Buckley, J, Coopey, SB, Gadd, M, Hughes, K, Specht, M & Smith, BL 2012, 'Cost comparison of radiation treatment options after lumpectomy for breast cancer', Annals of Surgical Oncology, vol. 19, no. 10, pp. 3275-3281. https://doi.org/10.1245/s10434-012-2546-5
Greenup, Rachel A. ; Camp, Melissa ; Taghian, Alphonse G. ; Buckley, Julliette ; Coopey, Suzanne B. ; Gadd, Michele ; Hughes, Kevin ; Specht, Michelle ; Smith, Barbara L. / Cost comparison of radiation treatment options after lumpectomy for breast cancer. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 10. pp. 3275-3281.
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abstract = "Background. Radiation therapy (RT) after lumpectomy for breast cancer can be delivered with several different regimens. We evaluated a cost-minimization strategy to select among RT options. Methods. An institutional review board (IRB)-A pproved retrospective review identified a sample of 100 women who underwent lumpectomy for invasive or in situ breast cancer during 2009. Post lumpectomy RT options included: no radiation in women ≥70 years [T1N0, estrogen receptor (ER)+] per Cancer and Leukemia Group B (CALGB) 9343 (no-RT), accelerated external-beam partial-breast irradiation (APBI), and Canadian fractionation (C-RT), as alternatives to standard whole-breast radiation therapy (WBRT). Eligibility for RT regimens was based on published criteria. RT costs were estimated using the 2011 US Medicare Physician Fee Schedule and average Current Procedural Terminology (CPT) codes billed per regimen at our institution. Costs were modeled in a 1,000-patient theoretical cohort. Results. Median patient age was 56.5 years (range 32-93 years). Tumor histology included invasive ductal cancer (78 {\%}), ductal carcinoma in situ (DCIS) (15 {\%}), invasive lobular cancer (6 {\%}), and mixed histology (1 {\%}). Median tumor size was 1 cm (range 0.2-5 cm). Estimated per-patient cost of radiation was US$5,341.81 for APBI, US$9,121.98 for C-RT, and US$13,358.37 for WBRT. When patients received the least expensive radiation regimen for which they were eligible, 14 {\%} received no-RT, 44 {\%} received APBI, 7 {\%} received C-RT, and 35 {\%} defaulted to WBRT. Using a cost-minimization strategy, estimated RT costs were US$7.67 million, versus US$13.36 million had all patients received WBRT, representing cost savings of US$5.69 million per 1,000 patients treated. Conclusions. A cost-minimization strategy results in a 43 {\%} reduction in estimated radiation costs among women undergoing breast conservation.",
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AU - Greenup, Rachel A.

AU - Camp, Melissa

AU - Taghian, Alphonse G.

AU - Buckley, Julliette

AU - Coopey, Suzanne B.

AU - Gadd, Michele

AU - Hughes, Kevin

AU - Specht, Michelle

AU - Smith, Barbara L.

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N2 - Background. Radiation therapy (RT) after lumpectomy for breast cancer can be delivered with several different regimens. We evaluated a cost-minimization strategy to select among RT options. Methods. An institutional review board (IRB)-A pproved retrospective review identified a sample of 100 women who underwent lumpectomy for invasive or in situ breast cancer during 2009. Post lumpectomy RT options included: no radiation in women ≥70 years [T1N0, estrogen receptor (ER)+] per Cancer and Leukemia Group B (CALGB) 9343 (no-RT), accelerated external-beam partial-breast irradiation (APBI), and Canadian fractionation (C-RT), as alternatives to standard whole-breast radiation therapy (WBRT). Eligibility for RT regimens was based on published criteria. RT costs were estimated using the 2011 US Medicare Physician Fee Schedule and average Current Procedural Terminology (CPT) codes billed per regimen at our institution. Costs were modeled in a 1,000-patient theoretical cohort. Results. Median patient age was 56.5 years (range 32-93 years). Tumor histology included invasive ductal cancer (78 %), ductal carcinoma in situ (DCIS) (15 %), invasive lobular cancer (6 %), and mixed histology (1 %). Median tumor size was 1 cm (range 0.2-5 cm). Estimated per-patient cost of radiation was US$5,341.81 for APBI, US$9,121.98 for C-RT, and US$13,358.37 for WBRT. When patients received the least expensive radiation regimen for which they were eligible, 14 % received no-RT, 44 % received APBI, 7 % received C-RT, and 35 % defaulted to WBRT. Using a cost-minimization strategy, estimated RT costs were US$7.67 million, versus US$13.36 million had all patients received WBRT, representing cost savings of US$5.69 million per 1,000 patients treated. Conclusions. A cost-minimization strategy results in a 43 % reduction in estimated radiation costs among women undergoing breast conservation.

AB - Background. Radiation therapy (RT) after lumpectomy for breast cancer can be delivered with several different regimens. We evaluated a cost-minimization strategy to select among RT options. Methods. An institutional review board (IRB)-A pproved retrospective review identified a sample of 100 women who underwent lumpectomy for invasive or in situ breast cancer during 2009. Post lumpectomy RT options included: no radiation in women ≥70 years [T1N0, estrogen receptor (ER)+] per Cancer and Leukemia Group B (CALGB) 9343 (no-RT), accelerated external-beam partial-breast irradiation (APBI), and Canadian fractionation (C-RT), as alternatives to standard whole-breast radiation therapy (WBRT). Eligibility for RT regimens was based on published criteria. RT costs were estimated using the 2011 US Medicare Physician Fee Schedule and average Current Procedural Terminology (CPT) codes billed per regimen at our institution. Costs were modeled in a 1,000-patient theoretical cohort. Results. Median patient age was 56.5 years (range 32-93 years). Tumor histology included invasive ductal cancer (78 %), ductal carcinoma in situ (DCIS) (15 %), invasive lobular cancer (6 %), and mixed histology (1 %). Median tumor size was 1 cm (range 0.2-5 cm). Estimated per-patient cost of radiation was US$5,341.81 for APBI, US$9,121.98 for C-RT, and US$13,358.37 for WBRT. When patients received the least expensive radiation regimen for which they were eligible, 14 % received no-RT, 44 % received APBI, 7 % received C-RT, and 35 % defaulted to WBRT. Using a cost-minimization strategy, estimated RT costs were US$7.67 million, versus US$13.36 million had all patients received WBRT, representing cost savings of US$5.69 million per 1,000 patients treated. Conclusions. A cost-minimization strategy results in a 43 % reduction in estimated radiation costs among women undergoing breast conservation.

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