Comparative cost-effectiveness of radiotherapy among older women with hormone receptor positive early-stage breast cancer

ABSTRACT

Objective

The aim was to examine the real-world cost-effectiveness of breast-conserving surgery (BCS) plus hormonal therapy with radiotherapy, compared to hormonal therapy alone among women 66 and older with hormone receptor positive early-stage breast cancer in the United States (US).

Methods

This study was conducted from a U.S. Centers for Medicare and Medicaid Services perspective and an eight-year time horizon. Both costs (2020 US$) and health utilities (quality-adjusted life years, QALYs) were obtained from retrospective studies using the SEER linked with Medicare and Medicare Health Outcomes Survey, respectively. The incremental cost-effectiveness ratio (ICER) of the addition of radiotherapy to hormonal therapy versus hormonal therapy alone after BCS was estimated by an unbiased doubly robust estimator. Sensitivity analyses were conducted through bootstrapping to estimate credible intervals.

Results

The addition of radiotherapy to hormonal therapy after BCS yielded the highest clinical benefits (2.66 QALYs) and costs ($19,424.27) compared to its hormonal therapy alone after BCS (0.77 QALYS; $2,028.58). The ICER was estimated to be $9,174.94/QALY. Sensitivity analyses did not change the direction of the findings.

Conclusions

The results implicated that the combination of radiotherapy and hormonal therapy is cost-effective in the US.

KEYWORDS:

• Comparative cost-effectiveness
• doubly robust estimator
• radiotherapy
• hormonal therapy
• early-stage breast cancer
• elderly women

Acknowledgments

This study used the linked SEER‐Medicare data. The interpretation and reporting of these data are the sole responsibility of the authors. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s (NCI) Surveillance, SEER Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under agreement # U58DP003862‐01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the authors and endorsement by the State of California Department of Public Health, the NCI, and the CDC and Prevention or their Contractors and Subcontractors is not intended nor should it be inferred. The author acknowledges the efforts of the NCI; the Office of Research, Development and Information, CMS; Information Management Services Inc.; and the SEER Program tumor registries in the creation of the SEER‐Medicare data.

Authors’ contributions

A Ali, R Tawk, V Diaby, R Moussa conceptualized and drafted the manuscript. All authors critically revised the manuscript and approved the final version.

Declaration of interest

V Diaby and R Tawk have disclosed that they were funded by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number G12MD007582. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities of the National Institutes of Health. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethics approval

The study was approved by the FAMU Institutional Review Board.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental data

Supplemental data for this article can be accessed here