Abstract
Aims The economic burden of cancer care is substantial, including steep increases in costs for breast cancer management. There is mounting evidence that women age ≥ 60 years with grade I/II T1N0 luminal A (ER/PR+, HER2– and Ki67 ≤ 13%) breast cancer have such low local recurrence rates that adjuvant breast radiotherapy might offer limited value. We aimed to determine the total savings to a publicly funded health care system should omission of radiotherapy become standard of care for these patients. Materials and methods The number of women aged ≥ 60 years who received adjuvant radiotherapy for T1N0 ER+ HER2– breast cancer in Ontario was obtained from the provincial cancer agency. The cost of adjuvant breast radiotherapy was estimated through activity-based costing from a public payer perspective. The total saving was calculated by multiplying the estimated number of luminal A cases that received radiotherapy by the cost of radiotherapy minus Ki-67 testing. Results In 2010, 748 women age ≥ 60 years underwent surgery for pT1N0 ER+ HER2– breast cancer; 539 (72%) underwent adjuvant radiotherapy, of whom 329 were estimated to be grade I/II luminal A subtype. The cost of adjuvant breast radiotherapy per case was estimated at $6135.85; the cost of Ki-67 at $114.71. This translated into an annual saving of about $2.0million if radiotherapy was omitted for all low-risk luminal A breast cancer patients in Ontario and $5.1million across Canada. Conclusion There will be significant savings to the health care system should omission of radiotherapy become standard practice for women with low-risk luminal A breast cancer.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 587-593 |
| Number of pages | 7 |
| Journal | Clinical Oncology |
| Volume | 28 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 1 2016 |
| Externally published | Yes |
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Keywords
- Breast cancer
- cost savings
- Ki-67
- luminal A
- omission
- radiotherapy
ASJC Scopus subject areas
- Oncology
- Radiology Nuclear Medicine and imaging
Cite this
Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer : Impact on Health Care Costs. / Han, K.; Yap, M. L.; Yong, J. H E; Mittmann, N.; Hoch, Jeffrey S; Fyles, A. W.; Warde, P.; Gutierrez, E.; Lymberiou, T.; Foxcroft, S.; Liu, F. F.
In: Clinical Oncology, Vol. 28, No. 9, 01.09.2016, p. 587-593.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer
T2 - Impact on Health Care Costs
AU - Han, K.
AU - Yap, M. L.
AU - Yong, J. H E
AU - Mittmann, N.
AU - Hoch, Jeffrey S
AU - Fyles, A. W.
AU - Warde, P.
AU - Gutierrez, E.
AU - Lymberiou, T.
AU - Foxcroft, S.
AU - Liu, F. F.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Aims The economic burden of cancer care is substantial, including steep increases in costs for breast cancer management. There is mounting evidence that women age ≥ 60 years with grade I/II T1N0 luminal A (ER/PR+, HER2– and Ki67 ≤ 13%) breast cancer have such low local recurrence rates that adjuvant breast radiotherapy might offer limited value. We aimed to determine the total savings to a publicly funded health care system should omission of radiotherapy become standard of care for these patients. Materials and methods The number of women aged ≥ 60 years who received adjuvant radiotherapy for T1N0 ER+ HER2– breast cancer in Ontario was obtained from the provincial cancer agency. The cost of adjuvant breast radiotherapy was estimated through activity-based costing from a public payer perspective. The total saving was calculated by multiplying the estimated number of luminal A cases that received radiotherapy by the cost of radiotherapy minus Ki-67 testing. Results In 2010, 748 women age ≥ 60 years underwent surgery for pT1N0 ER+ HER2– breast cancer; 539 (72%) underwent adjuvant radiotherapy, of whom 329 were estimated to be grade I/II luminal A subtype. The cost of adjuvant breast radiotherapy per case was estimated at $6135.85; the cost of Ki-67 at $114.71. This translated into an annual saving of about $2.0million if radiotherapy was omitted for all low-risk luminal A breast cancer patients in Ontario and $5.1million across Canada. Conclusion There will be significant savings to the health care system should omission of radiotherapy become standard practice for women with low-risk luminal A breast cancer.
AB - Aims The economic burden of cancer care is substantial, including steep increases in costs for breast cancer management. There is mounting evidence that women age ≥ 60 years with grade I/II T1N0 luminal A (ER/PR+, HER2– and Ki67 ≤ 13%) breast cancer have such low local recurrence rates that adjuvant breast radiotherapy might offer limited value. We aimed to determine the total savings to a publicly funded health care system should omission of radiotherapy become standard of care for these patients. Materials and methods The number of women aged ≥ 60 years who received adjuvant radiotherapy for T1N0 ER+ HER2– breast cancer in Ontario was obtained from the provincial cancer agency. The cost of adjuvant breast radiotherapy was estimated through activity-based costing from a public payer perspective. The total saving was calculated by multiplying the estimated number of luminal A cases that received radiotherapy by the cost of radiotherapy minus Ki-67 testing. Results In 2010, 748 women age ≥ 60 years underwent surgery for pT1N0 ER+ HER2– breast cancer; 539 (72%) underwent adjuvant radiotherapy, of whom 329 were estimated to be grade I/II luminal A subtype. The cost of adjuvant breast radiotherapy per case was estimated at $6135.85; the cost of Ki-67 at $114.71. This translated into an annual saving of about $2.0million if radiotherapy was omitted for all low-risk luminal A breast cancer patients in Ontario and $5.1million across Canada. Conclusion There will be significant savings to the health care system should omission of radiotherapy become standard practice for women with low-risk luminal A breast cancer.
KW - Breast cancer
KW - cost savings
KW - Ki-67
KW - luminal A
KW - omission
KW - radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=84964687247&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84964687247&partnerID=8YFLogxK
U2 - 10.1016/j.clon.2016.04.003
DO - 10.1016/j.clon.2016.04.003
M3 - Article
VL - 28
SP - 587
EP - 593
JO - Clinical Oncology
JF - Clinical Oncology
SN - 0936-6555
IS - 9
ER -