Abstract P1-10-02: Adjuvant radiation after lumpectomy: A cost comparison of treatment patterns in 43,247 women from the National Cancer Data Base
Authors: Greenup Rachel A , Blitzblau Rachel , Houck Kevin , Horton Janet , Howie Lynn , Palta Manisha , Mackey Aimee , Scheri Randy , Sosa Julie A , Taghian Alphonse G , Peppercorn Jeffrey , Smith Barbara L , Hwang E  Shelley 
Published: May 2015

Abstract
BACKGROUND: Breast cancer treatment contributes the greatest proportion of cancer-related health care spending in the United States. Locoregional therapy comprises a significant share of these costs. We hypothesized that among eligible women with early-stage breast cancer treated with lumpectomy, evidence-based utilization of hypofractionated whole breast radiation or omission of radiotherapy could substantially reduce cancer-related treatment costs.
METHODS: Using the National Cancer Data Base which captures approximately 70% of all newly diagnosed cancers in the United States, we identified 43,247 women with clinically node-negative, T1-T2 invasive breast cancers treated with lumpectomy during 2011. Women with DCIS, those treated with mastectomy, accelerated partial breast irradiation (APBI), or unknown or questionable radiation regimens were excluded. Adjuvant radiation was categorized into the following regimens: conventionally fractionated whole breast irradiation therapy (CF-WBI) [25-40 fractions, 45-66 Gy], hypofractionated whole-breast irradiation (HF-WBI) [15-24 fractions, 40-58 Gy), and lumpectomy without radiation (no RT). Women were considered eligible for no RT if ≥70 years with T1N0, ER+ breast cancers, and for HF-WBI if ≥50 years, with T1-T2 N0 invasive breast cancer. Treatment costs were calculated using Medicare Physician Fee Schedule payment information for 2011, and based on average current procedural codes billed per regimen. Costs per patient were estimated as follows: CF-WBI $13,358.37, HF-WBI $8,327.98, and lumpectomy without RT $0. Actual treatment costs were compared to evidence-based, reduced-cost radiation regimens for which patients were potentially eligible.
RESULTS: Median patient age was 63 years (range 19-90). Median tumor size was 1.2 cm. Of the total study cohort, 84.5% was eligible for HF-WBI, and 22.3% for no RT. Among the 36,562 (84.5%) patients eligible for treatment with HF-WBI, 28,383 (77.6%) received radiation therapy. Of these, 22,653 (79.8%) received CF-WBI, 5,289 (18.6%) received HF-WBI, and 441 (1.6%) received accelerated partial breast irradiation (APBI). Among 9,651 women ≥70 years with ER+ tumors eligible for no-RT, 4,245 (44.0%) received CF-WBI, 1,768 (18.3%) received HF-WBI, 153 (1.6%) received APBI, and 3,485 (36.1%) received no RT. 26% of women received the least expensive evidence-based radiation regimen for which they were eligible, while 67% of patients were treated with more costly radiation regimens. Estimated costs of actual treatment were $420.2 million during 2011, compared to $256.2 million had women been treated with the least expensive radiation regimen for which they were eligible. This translates into an annual cost savings of $164.0 million, a 39% reduction in costs.
CONCLUSIONS: Utilization of evidence-based adjuvant radiation following lumpectomy is associated with reductions in cancer-related costs in the locoregional treatment of early-stage breast cancer. Although treatment decisions should not be driven by health care costs alone, consideration of hypofractionated regimens or omission of radiotherapy for patients that fit evidence-based eligibility criteria could translate into dramatic reductions in annual health care spending.
Citation Format: Rachel A Greenup, Rachel Blitzblau, Kevin Houck, Janet Horton, Lynn Howie, Manisha Palta, Aimee Mackey, Randy Scheri, Julie A Sosa, Alphonse G Taghian, Jeffrey Peppercorn, Barbara L Smith, E Shelley Hwang. Adjuvant radiation after lumpectomy: A cost comparison of treatment patterns in 43,247 women from the National Cancer Data Base [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-10-02.