Incidence and Costs of Shorter Duration vs Conventional Irradiation After Breast Conserving Surgery

Bekelman et al in their study published in JAMA examined claims data from 14 commercial health care plans covering 7.4% of US adult women in 2013.   

They classified patients with early-stage breast cancer treated with lumpectomy and whole breast irradiation (WBI) from 2008 and 2013 into 2 cohorts: (1) the hypofractionation-endorsed cohort (n = 8924) that included patients aged 50 years or older without prior chemotherapy or axillary lymph node involvement and (2) the hypofractionation-permitted cohort (n = 6719) included patients younger than 50 years or those with prior chemotherapy or axillary lymph node involvement. Hypofractionated WBI (3-5 weeks of treatment) vs. conventional WBI (5-7 weeks of treatment).

Hypofractionated WBI increased from 10.6 in 2008 to 34.5% in 2013 in the hypofractionation-endorsed cohort and from 8.1% in 2008 to 21.2% in 2013 in the hypofractionation-permitted cohort. Adjusted mean total health care expenditures in the 1-year after diagnosis were $28747 for hypofractionated and $31641 for conventional WBI in the hypofractionation-endorsed cohort (difference, $2894; $1610-$4234; P < .001) and $64273 for hypofractionated and $72860 for conventional WBI in the hypofractionation-permitted cohort (difference, $8587; $5316-$12 017; P < .001). Adjusted mean total 1-year patient out-of-pocket expenses were not significantly different between hypofractionated vs. conventional WBI in either cohort.

They concluded that in spite the limitations of their study that they innumerate and discuss, hypofractionated WBI which is comparable in clinical efficacy, cosmesis, and toxicity after breast conserving surgery increased among women with early-stage breast cancer in 14 US commercial health care plans between 2008 and 2013. However, only 34.5% of patients with hypofractionation-endorsed and 21.2% with hypofractionation-permitted early-stage breast cancer received hypofractionated WBI in 2013.  Mean total health care expenditures for patients receiving hypofractionated WBI were about 10% less than for patients receiving conventional WBI.