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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

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


Authors

David Glynn

Judith Bliss

Charlotte E. Coles

Duncan Wheatley

Joanne S. Haviland

Anna M. Kirby

Francesco Longo

Rita Faria

John R. Yarnold

Susan Griffin



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.

Journal Article Type Article
Acceptance Date Oct 18, 2022
Publication Date Nov 17, 2022
Publicly Available Date Mar 29, 2024
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
Publisher URL https://link.springer.com/article/10.1007/s10549-022-06802-1

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