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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2012

01-10-2012 | Breast Oncology

Cost Comparison of Radiation Treatment Options After Lumpectomy for Breast Cancer

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

Published in: Annals of Surgical Oncology | Issue 10/2012

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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)-approved 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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Metadata
Title
Cost Comparison of Radiation Treatment Options After Lumpectomy for Breast Cancer
Authors
Rachel A. Greenup, MD, MPH
Melissa S. Camp, MD, MPH
Alphonse G. Taghian, MD, PhD
Julliette Buckley, MD
Suzanne B. Coopey, MD
Michele Gadd, MD
Kevin Hughes, MD
Michelle Specht, MD
Barbara L. Smith, MD, PhD
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2546-5

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