Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer

Impact on Health Care Costs

K. Han, M. L. Yap, J. H E Yong, N. Mittmann, Jeffrey S Hoch, A. W. Fyles, P. Warde, E. Gutierrez, T. Lymberiou, S. Foxcroft, F. F. Liu

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)587-593
Number of pages7
JournalClinical Oncology
Volume28
Issue number9
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Adjuvant Radiotherapy
Health Care Costs
Breast
Radiotherapy
Breast Neoplasms
Costs and Cost Analysis
Ontario
Delivery of Health Care
Standard of Care
Canada
Neoplasms
Economics
Recurrence

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 journalArticle

Han, K, Yap, ML, Yong, JHE, Mittmann, N, Hoch, JS, Fyles, AW, Warde, P, Gutierrez, E, Lymberiou, T, Foxcroft, S & Liu, FF 2016, 'Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer: Impact on Health Care Costs', Clinical Oncology, vol. 28, no. 9, pp. 587-593. https://doi.org/10.1016/j.clon.2016.04.003
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. / Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer : Impact on Health Care Costs. In: Clinical Oncology. 2016 ; Vol. 28, No. 9. pp. 587-593.
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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.

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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.

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