Examining the cost-effectiveness of radiation therapy among older women with favorable-risk breast cancer

Sounok Sen, Shi Yi Wang, Pamela R. Soulos, Kevin D. Frick, Jessica B. Long, Kenneth B. Roberts, James B. Yu, Suzanne B. Evans, Anees B. Chagpar, Cary P. Gross

Research output: Contribution to journalArticlepeer-review

Abstract

Background Little is known about the cost-effectiveness of external beam radiation therapy (EBRT) or newer radiation therapy (RT) modalities such as intensity modulated radiation (IMRT) or brachytherapy among older women with favorable- risk breast cancer. Methods Using a Markov model, we estimated the cost-effectiveness of no RT, EBRT, and IMRT over 10 years. We estimated the incremental cost-effectiveness ratio (ICER) of IMRT compared with EBRT under different scenarios to determine the necessary improvement in effectiveness for newer modalities to be cost-effective. We estimated model inputs using women in the Surveillance, Epidemiology, and End Results-Medicare database fulfilling the Cancer and Leukemia Group B C9343 trial criteria. Results The incremental cost of EBRT compared with no RT was $9500 with an ICER of $44 600 per quality-adjusted life year (QALY) gained. The ICERs increased with age, ranging from $38 300 (age 70-74 years) to $55 800 (age 80 to 94 years) per QALY. The ICERs increased to more than $63 800 per QALY for women aged 70 to 74 years with an expected 10-year survival of 25%. Reduction in local recurrence by IMRT compared with EBRT did not have a substantial impact on the ICER of IMRT. IMRT would have to increase the utility of baseline state by 20% to be cost-effective (<$100 000 per QALY). Conclusions EBRT is cost-effective for older women with favorable risk breast cancer, but substantially less cost-effective for women with shorter expected survival. Newer RT modalities would have to be substantially more effective than existing therapies in improving quality of life to be cost-effective.

Original languageEnglish (US)
Article numberdju008
JournalJournal of the National Cancer Institute
Volume106
Issue number3
DOIs
StatePublished - Mar 2014

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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