(Sunday, 7/12/2020) [Eastern Time (GMT-4)]
Room: AAPM ePoster Library
Purpose: analyze the cost-effectiveness of seven advanced post-mastectomy radiotherapy (PMRT) and six advanced whole breast radiation therapy (WBRT) techniques compared with standard of care (SOC).
Methods: Markov models, we estimated cost-effectiveness of intensity-modulated radiation therapy (IMRT), standard volumetric modulated arc therapy (STD-VMAT), non-coplanar VMAT (NC-VMAT), multiple arc VMAT(MA-VMAT), Tomotherapy (TOMO), bolus electron conformal therapy (BECT) mixed with IMRT and VMAT (MIXED), and intensity modulated proton therapy (IMPT) for a 55-year-old PMRT patient cohort over 15 years, and we estimated cost-effectiveness of field-in-field (FIF), hybrid IMRT, IMRT, STD-VMAT, MA-VMAT, NC-VMAT for a 65-year-old WBRT patient cohort over 15 years. Both tumor coverage and late side effects (cardiac toxicity and secondary cancers) after treatments were included in the analyses. Transition probabilities and utilities for each health state were obtained from literature. Costs incurred by payer were adopted from Medicare and literature data. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. Sensitivity analyses were performed to evaluate the impact of uncertainties in probabilities, utilities and costs of radiogenic side effects on the final results.
Results: PMRT patient cohort, IMRT is the most cost-effective technique with an ICER value of 27,310 $/QALY, and IMPT has the highest ICER of 74,564 $/QALY. One-way analyses show that the probability of cardiac toxicity has the most significant impact on model outcomes. For WBRT patient cohort, FIF is the most cost-effective technique with an ICER value of 1,511 $/QALY, and IMRT has the highest ICER of 121,087 $/QALY. One-way analyses show that the probability of developing contralateral breast cancer has the most significant impact on model outcomes.
Conclusion: a willingness-to-pay (WTP) threshold of 50,000 $/QALY, IMRT might be the most cost-effective option for PMRT patients, and FIF might be the most cost-effective option for WBRT patients.
Funding Support, Disclosures, and Conflict of Interest: The authors have no conflicts of interest. This work was partially supported by National Institutes of Health (grant no. K22CA204464).
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