September 15, 2012
2 min read

IORT may yield significant savings over other approaches

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SAN FRANCISCO — The use of intraoperative radiotherapy instead of other more common radiotherapy approaches could generate significant cost savings, according to study results.

“At a time of growing economic austerity and rising healthcare expenditure, there is an increasing need to consider treatment approaches that maximize treatment efficacy while reducing healthcare costs – intraoperative radiotherapy is one such modality,” Dennis R. Holmes, MD, FACS, director of the Los Angeles Center for Women’s Health, told HemOnc Today.

“By allowing complete delivery of radiotherapy as a single 30-minute treatment at the time of surgery, intraoperative radiotherapy greatly increases the feasibility of breast conservation by reducing the treatment burden and side effects of traditional 30-day whole breast radiotherapy and 5-day multilumen-balloon based radiotherapy. As a result, intraoperative radiotherapy is a ‘win-win-win’ solution in terms of treatment efficacy, cost-effectiveness, and feasibility.”

To determine potential cost savings associated with the use of single-fraction intraoperative radiotherapy compared with two other commonly used alternative radiotherapy approaches, Holmes and colleagues performed a database survey of women who underwent breast-conserving surgery with or without sentinel lymphadenectomy at HealthCare Partners, an independent physician association in Los Angeles.

The researchers evaluated data on 1,478 women to determine the average per-patient cost of breast radiotherapy comparing three modalities: single-fraction intraoperative radiotherapy, 5-day multi-lumen balloon brachytherapy, and standard 6-week whole breast external beam radiotherapy followed by a tumor bed boost.

Holmes and colleagues identified patients by cross-referencing ICD-9 codes for invasive breast cancer, CPT codes for breast-conserving surgery, and CPT codes for sentinel node biopsy without axillary lymph node dissection.

The researchers based calculations on the 2011 US Medicare Fee Schedule. They modeled treatment costs and savings on the assumption that patients with node-negative disease who underwent breast-conserving surgery were eligible for accelerated partial breast irradiation based on American Society of Breast Surgeons guidelines (age ≥45, infiltrating ductal carcinoma, ductal carcinoma in situ, size ≤3 cm, node and margin negative).

Study results showed single-fraction intraoperative radiotherapy cost $4,402. That was about 51% less expensive than standard 6-week whole breast external beam radiotherapy followed by a tumor bed boost ($8,988), and about 63% less expensive than 5-day multi-lumen balloon brachytherapy ($12,021).

“Intraoperative radiotherapy is a form of accelerated partial breast radiotherapy that has been shown to be equally efficacious as traditional 30-day whole breast radiotherapy and 5-day multilumen-balloon based radiotherapy,” said Holmes. “However, intraoperative radiotherapy is considerably more cost effective, reducing radiotherapy cost by 37-49% compared to alternative modalities.”

For more information:
Holmes DR. Abstract #187. Presented at: 2012 Breast Cancer Symposium; Sept. 13-15, 2012; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.