A comparative cost analysis of 25-fraction vs 5-fraction postoperative radiotherapy regimens for breast cancer.

Abstract

Purpose: To compare the costs of 25-fraction vs 5-fraction postoperative radiotherapy regimens in breast cancer patients. Several clinical trials have confirmed at least comparable safety and efficacy of short hypofractionated partial and whole breast radiation regimens. This study was focused on providing detailed cost data and analysing the advantages or disadvantages of either treatment strategy for patients.

Materials and methods: Calculations were performed based on patient and infra-structure data collected from the department of radiation oncology at Lucerne Cantonal Hospital (LUKS) in Switzerland from 1 July to 31 December 2020. The process maps were created to identify resources used for each radiation therapy option, from initial consultation to treatment completion. Cost comparisons represent the viewpoints of the hospital, insurance coverages and societal costs. To estimate hospital costs, time-driven activity-based costing was used, including equipment purchase and personnel costs. For insurers, estimates were based on the TARMED tariff system in Switzerland, which is used for billing ambulatory services and reflecting insurance coverage. The social cost was defined as productivity loss (e.g. absence from work) due to treatment appointments.

Results: The 5-fraction regimens resulted in a total of 53% (972 CHF) lower hospital costs, including personnel and equipment resources, a 42% (3153 CHF) reduction of charges to insurers and a 62% (372 CHF) lower social burden in terms of productivity losses due to the patient's absence from work. The major findings from studies using 5-fraction regimens have shown a comparable result in terms of local control and treatment tolerance.

Conclusion: A5-fraction radiotherapy regimen in breast cancer patients results in a lower cost than a conventional 25-fraction regimen.