Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer: Impact on Health Care Costs. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: Han, K.; Yap, M.L.; Yong, J.H.E.; Mittmann, N.; Hoch, J.S.; Fyles, A.W.; Warde, P.; Gutierrez, E.; Lymberiou, T.; Foxcroft, S.; Liu, F.F.
• Is Part Of: Clinical oncology. Volume 28:Issue 9(2016)
• Page Start: 587
• Page End: 593
• Publication Date: 2016-09
• Subjects: Breast cancer -- cost savings -- Ki-67 -- luminal A -- omission -- radiotherapy; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2016.04.003
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: The economic burden of cancer care is substantial, including steep increases in costs for breast cancer management. There is mounting evidence that women age ≥ 60 years with grade I/II T1N0 luminal A (ER/PR+, HER2– and Ki67 ≤ 13%) breast cancer have such low local recurrence rates that adjuvant breast radiotherapy might offer limited value. We aimed to determine the total savings to a publicly funded health care system should omission of radiotherapy become standard of care for these patients. Materials and methods: The number of women aged ≥ 60 years who received adjuvant radiotherapy for T1N0 ER+ HER2– breast cancer in Ontario was obtained from the provincial cancer agency. The cost of adjuvant breast radiotherapy was estimated through activity-based costing from a public payer perspective. The total saving was calculated by multiplying the estimated number of luminal A cases that received radiotherapy by the cost of radiotherapy minus Ki-67 testing. Results: In 2010, 748 women age ≥ 60 years underwent surgery for pT1N0 ER+ HER2– breast cancer; 539 (72%) underwent adjuvant radiotherapy, of whom 329 were estimated to be grade I/II luminal A subtype. The cost of adjuvant breast radiotherapy per case was estimated at $6135.85; the cost of Ki-67 at $114.71. This translated into an annual saving of about $2.0million if radiotherapy was omitted for all low-risk luminal A breast cancer patients in Ontario and $5.1million across Canada. Conclusion: There will be significant savings to the health care system should omission of radiotherapy become standard practice for women with low-risk luminal A breast cancer. Highlights: To estimate cost savings of omitting radiotherapy in low-risk luminal A breast cancer. The cost of adjuvant breast radiotherapy per case was estimated at $6135.85. This translates into an annual saving of about $2 million in Ontario and $5 million across Canada.