Cost-effectiveness of 5 fraction and partial breast radiotherapy for early breast cancer in the UK: model-based multi-trial analysis.

Glynn, David; Bliss, Judith; Brunt, Adrian Murray; Coles, Charlotte E.; Wheatley, Duncan; Haviland, Joanne S.; Kirby, Anna M.; Longo, Francesco; Faria, Rita; Yarnold, John R.; Griffin, Susan

Abstract

PURPOSE: We estimated the cost-effectiveness of 4 radiotherapy modalities to treat early breast cancer in the UK. In a subgroup of patients eligible for all modalities, we compared whole-breast (WB) and partial breast (PB) radiotherapy delivered in either 15 (WB15F, PB15F) or 5 fractions (WB5F, PB5F). In a subgroup ineligible for PB radiotherapy, we compared WB15F to WB5F. METHODS: We developed a Markov cohort model to simulate lifetime healthcare costs and quality-adjusted life years (QALYs) for each modality. This was informed by the clinical analysis of two non-inferiority trials (FAST Forward and IMPORT LOW) and supplemented with external literature. The primary analysis assumed that radiotherapy modality influences health only through its impact on locoregional recurrence and radiotherapy-related adverse events. RESULTS: In the primary analysis, PB5F had the least cost and greatest expected QALYs. WB5F had the least cost and the greatest expected QALYs in those only eligible for WB radiotherapy. Applying a cost-effectiveness threshold of £15,000/QALY, there was a 62% chance that PB5F was the cost-effective alternative in the PB eligible group, and there was a 100% chance that WB5F was cost-effective in the subgroup ineligible for PB radiotherapy. CONCLUSIONS: Hypofractionation to 5 fractions and partial breast radiotherapy modalities offer potentially important benefits to the UK health system.

Citation

Glynn, D., Bliss, J., Brunt, A. M., Coles, C. E., Wheatley, D., Haviland, J. S., …Griffin, S. (2022). Cost-effectiveness of 5 fraction and partial breast radiotherapy for early breast cancer in the UK: model-based multi-trial analysis. Breast Cancer Research and Treatment, 197, 405-416. https://doi.org/10.1007/s10549-022-06802-1

• Journal Article Type: Article
• Acceptance Date: Oct 18, 2022
• Publication Date: Nov 17, 2022
• Journal: Breast Cancer Research and Treatment
• Print ISSN: 0167-6806
• Electronic ISSN: 1573-7217
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 197
• Pages: 405-416
• DOI: https://doi.org/10.1007/s10549-022-06802-1
• Public URL: https://keele-repository.worktribe.com/output/425089
• Publisher URL: https://link.springer.com/article/10.1007/s10549-022-06802-1