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Author Mailhot Vega, Raymond B. ♦ Ishaq, Omar ♦ Raldow, Ann ♦ Perez, Carmen A. ♦ Jimenez, Rachel ♦ Scherrer-Crosbie, Marielle ♦ Bussiere, Marc ♦ Taghian, Alphonse ♦ Sher, David J. ♦ MacDonald, Shannon M.
Source United States Department of Energy Office of Scientific and Technical Information
Content type Text
Language English
Subject Keyword RADIOLOGY AND NUCLEAR MEDICINE ♦ CARDIOVASCULAR DISEASES ♦ COST EFFECTIVENESS ANALYSIS ♦ GY RANGE 01-10 ♦ HEART ♦ IRRADIATION ♦ MAMMARY GLANDS ♦ NEOPLASMS ♦ PATIENTS ♦ PROBABILISTIC ESTIMATION ♦ PROTON BEAMS ♦ RADIATION HAZARDS ♦ RADIOTHERAPY ♦ SENSITIVITY ANALYSIS ♦ SIDE EFFECTS ♦ STANDARD OF LIVING ♦ WOMEN
Abstract Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. Methods and Materials: A Markov cohort model was constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. Results: Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve an MHD <5 Gy.
ISSN 03603016
Educational Use Research
Learning Resource Type Article
Publisher Date 2016-05-01
Publisher Place United States
Journal International Journal of Radiation Oncology, Biology and Physics
Volume Number 95
Issue Number 1


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