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Publications

Randomized Controlled Trial Journal Article Research Support, Non-U.S. Gov't Ppublish 3 citations

PubMed: 37480995 DOI: 10.1016/j.radonc.2023.109818

Economic evaluation and budget-impact of accelerated partial breast irradiation (APBI) versus standard or hypofractionated whole breast irradiation (WBI) in postmenopausal women with early-stage breast cancer. Results from the French SHARE randomized trial.

Radiother Oncol 187:109818

Authors: Alicia Le Bras, Yazid Belkacemi, Celine Bourgier, Isabelle Gabelle-Flandin, Adeline Petit, Philippe Guilbert, Julien Geffrelot, Severine Racadot, Eleonor Rivin Del Campo, Chantal Hanzen, Claire Charra Brunaud, Guillaume Auzac, Thomas Lacornerie, Jerome Lemonnier, Eric Lartigau, Isabelle Durand-Zaleski

Affiliations

  • Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Clinical Research Unit Eco Ile de France, 75004, Paris, France.
  • Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor University Hospital, Radiation Oncology Department and Henri Mondor Breast Center and INSERM Unit 955, Immunoregulation and Biotherapy (I-Biot) Team, The Mondor Institute for Biomedical Research (IMRB), Creteil, France.
  • Institut de cancérologie Gustave-Roussy, Département de radiothérapie, 114 rue Édouard-Vaillant, Villejuif, France.
  • Centre Hospitalier Universitaire Grenoble Alpes, Clinique Universitaire de Cancérologie-Radiothérapie, 38000, Grenoble, France.
  • Institut Bergonié, Department of Radiotherapy, 229 Cours de L'Argonne, 33076, Bordeaux, France.
  • Institut Godinot, Department of Radiation Therapy, Reims, France.
  • Centre François Baclesse, Department of Radiation Oncology, Caen, France.
  • Centre Léon Berard, Radiation Oncology, Lyon, France.
  • Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon University Hospital, Department of Radiation Oncology, Paris 75020, France.
  • Centre Henri Becquerel, UNICANCER, Department of Oncology, Rouen, France.
  • Institut de Cancérologie de Lorraine, Department of Radiotherapy and Brachytherapy, Vandoeuvre-Lès-Nancy, France.
  • Institut d'Oncologie Thoracique (IOT), Department of Radiation Oncology, Gustave Roussy, F-94805, Villejuif, France.
  • Centre Oscar Lambret, Department of Medical Physics, 59020, Lille, France.
  • Research and Development Department, UNICANCER, Paris, France.
  • Centres Oscar Lambret et Université de Lille, Lille, France.
  • Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Clinical Research Unit Eco Ile de France, CRESS-UMR1153, 75004, Paris, France.

Abstract

PURPOSE

This economic evaluation reports the incremental cost-utility ratio and national budget impact in France of accelerated partial breast irradiation (APBI) vs standard or hypofractionated whole breast irradiation (WBI) in breast cancer patients at low risk of local recurrence.

MATERIALS AND METHODS

We compared 490 women randomized to the APBI (ten fractions delivered twice daily over one week) with 488 women in the WBI arm (one fraction per day delivered five days per week over three or six weeks). We took the perspective of the French national health insurance with a three-year time horizon. The outcome was quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio was estimated and uncertainty was explored by probabilistic bootstrapping. Transportation and sick leave costs were added in a sensitivity analysis and a national budget impact analysis based on the incidence of breast cancer estimates in France performed.

RESULTS

At three years, the average cost per patient was €2,549 (±1,954) in the APBI arm and €4,468 (±1,586) in the WBI arm (p-value < 0.001), radiotherapy was the main driver of the difference between the two arms. No significant difference was found in QALYs. For an average of 60,000 new cases of breast cancer diagnosed annually in France, 28,000 would be eligible for treatment with APBI. A 100% uptake of APBI would result in a yearly30 million€ cost saving.

CONCLUSION

APBI for the treatment of postmenopausal women with early-stage breast cancer is cost saving, with no difference in outcome measured by QALYs.

MeSH

Radiotherapy, Breast Neoplasms, Cost Savings, Neoplasms, Breast, Budgets, Quality-Adjusted Life Years, Therapeutics, Medical Oncology