Cost-Effectiveness Comparison of Whole Breast Irradiation, Brachytherapy, and No Radiation Treatment in Elderly Patients with Breast Cancer

• Activity Number: 37
• Type: Contributed
• Date/Time: Sunday, July 29, 2012 : 2:00 PM to 3:50 PM
• Sponsor: Business and Economic Statistics Section
• Author(s): Jing Jiang*+ and Jinhai Huo and Hui Zhao and Weiguo He and Benjamin D. Smith
• Companies: MD Anderson Cancer Center and MD Anderson Cancer Center and The University of Texas School of Public Health and The University of Texas School of Public Health and MD Anderson Cancer Center
• Keywords: cost-effectiveness ; seer medicare ; propensity score ; radiation therapy ; subsequent mastectomy ; breast cancer

Abstract

We identified 41,683 patients aged 66 years and older from the SEER Medicare database that had been diagnosed with breast cancer between 2001 to 2007 and treated with lumpectomy followed by whole breast irradiation (WBI) or brachytherapy (BT) or no radiation treatment (NRT). The cost data for each patient were calculated by adding Medicare claims from 2000 to 2009. The benefit was the 5-year subsequent mastectomy survival rate which was calculated from the Kaplan-Meier statistical method. Cost-effectiveness was estimated using a propensity-score net monetary benefits value approach. The 5-year occurrence rate of mastectomy was lowest in patients treated with WBI (1.31% vs. 3.19 % in BT, P< 0.001, and 1.31% vs. 4.04% in NRT, p< 0.001). BT was dominated by WBI. The incremental cost-effectiveness of WBI versus NRT was $20,980 per mastectomy prevented, or $23,947 after being adjusted for propensity score. In this study, we determined the effectiveness and cost-effectiveness of WBI and BT versus NRT in a large population-based patient sample. The use of WBI as primary radiation therapy to prevent mastectomy may be cost-effective, depending on willingness to pay.