Abstract P3-19-07: Hypofractionated and conventional whole-breast radiotherapy for breast cancer patients: Financial risk and expenditures in the U.S. 2008-2017
Authors: Saulsberry Loren , Liao Chuanhong , Huo Dezheng 
Published: March 2022

Abstract
Background: Rising cancer care expenditures and technological advancement of shorter radiotherapy regimens have drawn significant attention to the use of hypofractionated radiotherapy in clinical care. We examine the costs of hypofractionated (HF-WBI) compared to conventional whole breast irradiation (CF-WBI) in the U.S. through 2017 and investigate the influences of patient characteristics and commercial insurance on HF-WBI use. Methods: In a retrospective study using private employer-sponsored insurance claims, a pooled cross-sectional evaluation of radiotherapy in patients with commercial insurance was performed from 2008-2017. The study population included female patients with early-stage breast cancer treated with lumpectomy and whole-breast irradiation. HF-WBI is defined as receipt of 15-24 radiation fractions and/or radiation fractions delivered between 21-31 days. CF-WBI is defined as receipt of 25-40 fractions and/or radiation fractions delivered between 39-120 days. The primary outcomes and measures were the use of HF-WBI and CF-WBI and total radiotherapy expenditures, including costs incurred by insurers and patient out-of-pocket expenses. Results: A total of 15,869 women received HF-WBI and 59,328 received CF-WBI. HF-WBI use increased from 2008 to 2017. Community-level factors like a higher proportion of college graduates and greater mixed racial composition were associated with increased HF-WBI use. No association was observed between insurance plan characteristics and the likelihood of receiving HF-WBI. The mean insurer-paid radiotherapy expenditures were significantly lower for HF-WBI vs. CF-WBI (adjusted difference $6,375, 95% CI $6,147-$6,603). The mean patient out-of-pocket expenditure for HF-WBI was $139 less than that of CF-WBI (Table 1). Geographic variation existed across U.S. states in HF-WBI use (range: 9.6%-36.2%). There was no consistent relationship across states between the utilization of HF-WBI and the corresponding average cost differences for HF-WBI relative to CF-WBI.
Conclusions: If trends continue, HF-WBI will soon become the dominant form of radiation treatment in the U.S. Although HF-WBI represents significant savings to the health care system and individual patients, no evidence indicated that a financial disincentive slowed the adoption of HF-WBI. Therefore, multi-level approaches, including individuals, the community, and health policy, should be utilized to promote cost-effective cancer care.
Table 1.Radiotherapy-related expenditures for breast cancer patients aged &lt;65 yrs with commercial insurance plans.aRadiotherapy TypeDifferences, US $bCF-WBIHF-WBIa2008-2017 [Adjusted Mean (95% CI), US $b]Total costs23,286 (23,158 to 23,415)16,763 (16,583 to 16,945)6,253 (6,294 to 6,751)Insurer paid22,751 (22,623 to 22,880)16,376 (16,196 to 16,557)6,375 (6,147 to 6,603)Patient OOP costs502 (491 to 513)363 (206 to 229)139 (119 to 160)aMultivariable generalized linear models with Gamma distribution and log link, with the adjustment for year of radiotherapy, state of beneficiary health plan, age at the time of radiotherapy, type of breast cancer diagnosis, receipt of chemotherapy, Charlson comorbidity index, community education level (% in the community with a college degree or higher), and type of insurance plan. All the differences were statistically significant with p&lt;0.0001. bAll expenditures were rounded up to the nearest dollar amount in 2017 U.S. dollars after adjusting for inflation. CF-WBI: conventional fractionated whole breast irradiation therapy. HF-WBI: hypofractionated WBI. OOP: out of pocket. CI: confidence intervals.
Citation Format: Loren Saulsberry, Chuanhong Liao, Dezheng Huo. Hypofractionated and conventional whole-breast radiotherapy for breast cancer patients: Financial risk and expenditures in the U.S. 2008-2017 [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-19-07.