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Title: Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation

Abstract

Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. Methods and Materials: A Markov cohort model was constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. Results: Protonmore » RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve an MHD <5 Gy.« less

Authors:
;  [1];  [2];  [1];  [3];  [4]; ;  [3];  [5]
  1. Department of Radiation Oncology, NYU School of Medicine, New York, New York (United States)
  2. Radiation Oncology Program, Harvard University, Boston, Massachusetts (United States)
  3. Department of Radiation Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States)
  4. Cardiovascular Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (United States)
  5. Department of Radiation Oncology, University of Texas Southwestern Medical Center, San Antonio, Texas (United States)
Publication Date:
OSTI Identifier:
22648613
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 95; Journal Issue: 1; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARDIOVASCULAR DISEASES; COST EFFECTIVENESS ANALYSIS; GY RANGE 01-10; HEART; IRRADIATION; MAMMARY GLANDS; NEOPLASMS; PATIENTS; PROBABILISTIC ESTIMATION; PROTON BEAMS; RADIATION HAZARDS; RADIOTHERAPY; SENSITIVITY ANALYSIS; SIDE EFFECTS; STANDARD OF LIVING; WOMEN

Citation Formats

Mailhot Vega, Raymond B., Ishaq, Omar, Raldow, Ann, Perez, Carmen A., Jimenez, Rachel, Scherrer-Crosbie, Marielle, Bussiere, Marc, Taghian, Alphonse, Sher, David J., and MacDonald, Shannon M., E-mail: smacdonald@partners.org. Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2016.02.031.
Mailhot Vega, Raymond B., Ishaq, Omar, Raldow, Ann, Perez, Carmen A., Jimenez, Rachel, Scherrer-Crosbie, Marielle, Bussiere, Marc, Taghian, Alphonse, Sher, David J., & MacDonald, Shannon M., E-mail: smacdonald@partners.org. Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation. United States. doi:10.1016/J.IJROBP.2016.02.031.
Mailhot Vega, Raymond B., Ishaq, Omar, Raldow, Ann, Perez, Carmen A., Jimenez, Rachel, Scherrer-Crosbie, Marielle, Bussiere, Marc, Taghian, Alphonse, Sher, David J., and MacDonald, Shannon M., E-mail: smacdonald@partners.org. Sun . "Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation". United States. doi:10.1016/J.IJROBP.2016.02.031.
@article{osti_22648613,
title = {Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation},
author = {Mailhot Vega, Raymond B. and Ishaq, Omar and Raldow, Ann and Perez, Carmen A. and Jimenez, Rachel and Scherrer-Crosbie, Marielle and Bussiere, Marc and Taghian, Alphonse and Sher, David J. and MacDonald, Shannon M., E-mail: smacdonald@partners.org},
abstractNote = {Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. Methods and Materials: A Markov cohort model was constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. Results: Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve an MHD <5 Gy.},
doi = {10.1016/J.IJROBP.2016.02.031},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 1,
volume = 95,
place = {United States},
year = {2016},
month = {5}
}