Abstract P1-10-18: The use of hypofractionated radiotherapy for the treatment of women with early breast cancer in the Brazilian public health system may increase access to treatment: Cost effectiveness and budget impact analyses
Authors: Andrade TRdM , Nazário ACP , Fonseca MCM 
Published: March 2017

Abstract
OBJECTIVES: To evaluate the cost effectiveness and economic impact of increasing the use of hypofractionated radiotherapy for the treatment of women older than 50 years, with early breast cancer(stages I and II) within the Brazilian National Health System(SUS).METHODS:Several studies show no difference concerning efficacy and safety between hypofractionated and conventional radiotherapy for the treatment of women older than 50 years with stages I and II disease.We built a cost-effectiveness Markov model in Excel which quantifies the cost and the amount of photon beams linear accelerator time used for the treatment of patients using hypofractionated(2.67Gy/fraction) or conventional(2Gy/fraction).The time horizon is 5 years.The perspective of the study is the SUS.The effectiveness was measured as amount of hours saved using hypofractionated in relation to conventional radiotherapy.Costs related to treatment are from DATASUS,and considered the cost of planning the radiotherapy, of the check-film and the use of photon beams linear accelerator.The discount we applied was 5% for costs and benefits.We performed univariate and probabilistic sensitivity analyses. The treatment fraction time was set as 15 minutes. We also built, in Excel, a budget impact model to simulate the increasing adoption of hypofractionated radiotherapy instead of conventional radiotherapyin the treatment of Brazilian women older than 50 years with early breast cancer.The model compares hypofractionated radiotherapy(2.67Gy/fraction) with conventional radiotherapy(2 Gy/fraction).We determined the number of women over 50 years with stages 1 and 2 breast malignant neoplasm that underwent adjuvant radiotherapy in 2013 and 2014, and then projected these populations for the years 2016 to 2020.We considered the costs of planning the radiotherapy, using the photon beams linear accelerator, and performing the check-film.We considered a yearly increase of 20% in the adoption of hypofractionated radiotherapy for the years 2016 to 2019(2016 20%;2017 40%;2018 60%;2019 80% and 2020 90%).The treatment fraction time was set as 15 minutes. RESULTS: The use of hypofractionated radiotherapy at 5 years was able to decrease the number of hours of treatment(-21,835hours) and the total cost of treatment (-$11,790,229.64).The technology is cost saving.Based on the budget impact analysis, the annual incremental impact would be of -$243,202.65, -$490,294.13, -$741,085.61, -$995,388.73 and -$1,127,712.81 providing 3,378, 6.810, 10,294, 13,826 and 15,664 free hours of the linear accelerator for the years 2016, 2017, 2018, 2019 and 2020, respectively.These photon beams linear accelerator free hours may allow 613, 1,380, 2,306, 3,392 and 4,010 additional patients to have access to breast cancer treatment during the years of 2016 to 2020 respectively. CONCLUSIONS:Considering the conditions proposed in these models increasing the use of hypofractionation as a radiotherapy technique to treat women older than 50 years, with early breast cancer within seems to increase the system efficiency saving money, optimizing the treatment schedule and providing access to treatment for more patients.
Citation Format: Andrade TRdM, Nazário ACP, Fonseca MCM. The use of hypofractionated radiotherapy for the treatment of women with early breast cancer in the Brazilian public health system may increase access to treatment: Cost effectiveness and budget impact analyses [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-18.