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Cost-Effectiveness of Treatment Approaches for Low-Risk Ductal Carcinoma in Situ
Study findings suggest no adjuvant therapy is the most cost-effective approach for postmenopausal women who receive partial mastectomy for low-risk ductal carcinoma in situ (DCIS; JCO Oncol Pract. 2021;17[8]:e1055-e1074. doi:10.1200/OP.20.00992).
“Adjuvant therapy in patients with ductal carcinoma in situ who undergo partial mastectomy remains controversial, particularly for low-risk patients,” explained Matthew C Ward, MD, Levine Cancer Institute, Atrium Health, Charlotte, NC, and colleagues.
This cost-effectiveness analysis compared three treatment strategies for patients with DCIS: no adjuvant treatment after surgery, a five-fraction course of accelerated partial breast irradiation (APBI) using intensity-modulated radiation therapy, or APBI plus an aromatase inhibitor for 5 years.
Researchers modeled outcomes, including local recurrence, distance metastases, survival, and toxicity, using a patient-level Markov microsimulation model. The model was validated against trial data.
The study included costs of treatment and possible adverse events from the societal perspective over a lifetime horizon. Costs were extracted from Medicare reimbursement data and adjusted to 2019 US dollars. Quality-adjusted life-years (QALYs)were calculated based on utilities pulled from the literature.
The costs were $5744 with no adjuvant therapy, $11,070 for APBI alone, and $16,052 for APBI plus an aromatase inhibitor. The QALYs associated with each approach were 11.32, 11.343, and 11.381, respectively.
In the base case, no treatment was the cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of $239,109/QALY for APBI alone and $171,718/QALY for for APBI plus an aromatase inhibitor. ICER for APBI plus an aromatase inhibitor compared with APBI alone was $131,949.
Using probabilistic sensitivity analyses, researchers found no therapy was considered cost-effective in 63% of trials, APBI alone was considered cost-effective in 19% of trials, and APBI plus an aromatase inhibitor in 18%.
“No adjuvant therapy represents the most cost-effective approach for postmenopausal women 60 years or older who receive partial mastectomy for low-risk ductal carcinoma in situ,” concluded Dr Ward and colleagues.—Janelle Bradley
