Omitting radiotherapy as a part of standard care for women with low-risk luminal A (low-grade, estrogen receptor-positive) breast cancer would produce significant cost savings without adversely affecting outcomes, according to a new study.
Conventional treatment of breast cancer advises adjuvant radiotherapy after breast-conserving surgery (BCS), which has been shown to reduce local recurrence and improve long-term survival. However, for patients with early stage disease, the likelihood of recurrence is already low enough that radiotherapy, which is associated with high costs and painful side effects, may not be needed.
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To explore this, researchers led by Kathy Han, MD, MSc, Princess Margaret Cancer Center (Ontario, Canada), conducted a study to determine the total cost savings to a publically funded health care system if radiotherapy was omitted as a standard of care for patients with breast cancer. Their results were published in Clinical Oncology.
Researchers used data collected by Cancer Care Ontario to look at records of breast cancer cases from 2010 and 2011. In each year, they identified 748 and 773 patients, respectively, who were 60 years of age or older and underwent surgery for breast cancer. In total, 539 patients (72%) and 556 patients (72%) received adjuvant radiotherapy as part of their care in 2010 and 2011, respectively. Researchers estimated that the net savings for omitting intensity-modulated radiotherapy (IMRT) for each case was $6021.14.
Because the use of IMRT has been steadily increasing since 2011, with 97.5% of cases treated with IMRT in 2013, the researchers estimated that omitting IMRT use in low-risk patients would result in total cost savings of $2 million dollars. And, understanding that 39% of new breast cancer cases were diagnosed in Ontario, the total cost savings for all of Canada could total more than $5 million, the researchers concluded.
When the cost of Ki-67 testing—which helps providers to understand cell proliferation and cancer growth—was also considered, researchers used best- and worst-case scenarios to represent potential savings. If the proportion of luminal A breast cancer, radiotherapy cost, and IMRT utilization all decreased while the cost of Ki-67 testing grew, savings would fall slightly to ~$1.5 million (worst case). If the proportion of luminal A breast cancer and cost of radiotherapy both increased while Ki-testing costs decreased, potential annual savings would be almost $3 million for Ontario and $7.4 million across Canada (best case).
Conversely, in an analysis of external beam radiation therapy, researchers found that it was significantly more cost-effective than IMRT for women aged 70 years and older with low-risk breast cancer ($44,600 per quality-adjusted life-year [QALY] vs $100,000 per QALY). However, it became considerably less cost-effective as patients’ life expectancies declined.
This current cost analysis showed substantial savings to a publicly funded health care system with the omission of radiotherapy from standard of care for women aged 60 years or older with luminal A breast cancer. The study authors suggested that more research be conducted on biomarkers for patients with lower risk of cancer recurrence and to develop treatment regimens that are more personalized for these patient groups. –Sean McGuire
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