Study Explores the Cost-Effectiveness of Ultra-Hypofractionated Whole Breast Radiation Therapy vs Endocrine Therapy Alone vs Combination Therapy

The use of 5-fraction ultra-hypofractionated whole-breast irradiation (U-WBI) monotherapy seems to be the more cost-effective therapy approach when compared to monotherapy hormone monotherapy , according to results from a recent cost-utility analysis (Int J Radiat Oncol Biol Phys. 2022; S0360-3016(22)03678-1. doi:10.1016/j.ijrobp.2022.12.028).

Matthew Ward, MD, Levine Cancer Institute, Atrium Health, Charlotte, NC, and colleagues indicated that the use of U-WBI has been associated with comparable outcomes to longer courses, decreasing the cost and inconvenience of treatment according to findings from recent trials.

Employing a Markov microsimulation model, Ward and colleagues conducted a cost-utility analysis to compare U-WBI to hormone therapy alone or their combination and replicated three different therapeutic methods for women aged 65 years or older who were diagnosed with pT1-2N0 ER-positive invasive ductal carcinoma treated with lumpectomy with negative margins.

The approaches included U-WBI performed with a three-dimensional conformal technique over five fractions without a boost ("RT Alone"), the use of anastrozole for five years as an adjuvant hormone therapy without RT ("AI Alone"), or the blend of the two therapies.

To match trial results, the relative effectiveness of the RT Alone and AI Alone approaches were inferred from previous randomized trials and the researchers adjusted the combination approach.

The authors wrote that “The primary endpoint was the cost-effectiveness of the 3 strategies over a lifetime horizon as measured by the incremental cost-effectiveness ratio (ICER), with a value of $100,000/quality-adjusted life-year deemed “cost-effective.”

Results indicated on average, RT Alone was the least expensive approach with a cost reported at $14,775, with AI Alone marginally more reported at a cost of $14,998, and combination therapy was the costliest at $19,802.

Results documented by the authors included, “RT alone dominated AI alone (the incremental cost-effectiveness ratio [ICER] –$5089),” adding, “Combination therapy, compared with RT alone, was slightly more expensive than our definition of cost-effective (ICER $113,468) but was cost-effective compared with AI alone (ICER $54,451).” The authors noted that “Probabilistic sensitivity analysis demonstrated RT alone to be cost-effective in 50% of trials, with combination therapy in 36% and AI alone in 14%.”

The authors concluded that when compared to monotherapy with AI, the use of monotherapy with U-WBI seems to be a more cost-effective de-escalation approach to treatment.  Lastly, the authors indicated that the combination of both therapies is a preferred option for some patients however, it is the most expensive.