Cost Differences Identified for Older Patients With Breast Cancer Undergoing Various Treatments

Researchers found that use of both aromatase inhibitor (AI-alone) and accelerated partial-breast irradiation using intensity-modulated radiation therapy alone are appropriate options for older patients with breast cancer, according to the results of a recent cost-effectiveness analysis. (Breast Cancer Res Treat. 2020;182[2]:355-365. doi:10.1007/s10549-020-05706-2) 

The research team, led by Matthew Ward, MD, Levine Cancer Institute, Atrium Health, and colleagues, included three strategies in their cost analysis for the adjuvant treatment of early breast cancer in women age 70 years or older. The strategies included: AI-alone for 5 years, a 5-fraction course of APBI-alone, or their combination. 

Dr Ward and colleagues developed a patient-level Markov microsimulation from a societal perspective. When it was possible, they used randomized trials to gather both effectiveness data and toxicity data. They included the costs of side effects and also adjusted these costs to 2019 US dollars. 

According to the study findings, Dr Ward’s team found that AI-alone was cheaper than APBI-along and combination therapy (AI alone $12,637; APBI-alone $13,799; combination $18,012). Of important note, all of the treatment options results in similar QALY outcomes (AI-alone 7.775; APBI-alone 7.768; combination 7.807).

“In the base case, AI-alone was the cost-effective strategy and dominated APBI-alone, while combined therapy was not cost-effective when compared to AI-alone ($171,451/QALY) or APBI-alone ($107,932/QALY),” explained the study authors. “In probabilistic sensitivity analyses, AI-alone was cost-effective at $100,000/QALY in 50% of trials, APBI-alone in 28% and the combination in 22%.”

Finally, the authors noted that based on a scenario analysis, APBI-alone was more effective than AI-alone when AI compliance was lower than 26% at 5 years.  

“Based on a Markov microsimulation analysis, both AI-alone and APBI-alone are appropriate options for patients 70 years or older with early breast cancer with small cost differences noted,” they concluded.—Julie Gould