Comparative cost-effectiveness of radiotherapy among older women with hormone receptor positive early-stage breast cancer

The aim was to examine the real-world cost-effectiveness of breast-conserving surgery (BCS) plus hormonal therapy with radiotherapy, compared to hormonal therapy alone among women 66 and older with hormone receptor positive early-stage breast cancer in the United States (US). This study was conducted from a U.S. Centers for Medicare and Medicaid Services perspective and an eight-year time horizon. Both costs (2020 US$) and health utilities (quality-adjusted life years, QALYs) were obtained from retrospective studies using the SEER linked with Medicare and Medicare Health Outcomes Survey, respectively. The incremental cost-effectiveness ratio (ICER) of the addition of radiotherapy to hormonal therapy versus hormonal therapy alone after BCS was estimated by an unbiased doubly robust estimator. Sensitivity analyses were conducted through bootstrapping to estimate credible intervals. The addition of radiotherapy to hormonal therapy after BCS yielded the highest clinical benefits (2.66 QALYs) and costs ($19,424.27) compared to its hormonal therapy alone after BCS (0.77 QALYS; $2,028.58). The ICER was estimated to be $9,174.94/QALY. Sensitivity analyses did not change the direction of the findings. The results implicated that the combination of radiotherapy and hormonal therapy is cost-effective in the US.

本研究旨在考察美国66岁及以上激素受体阳性早期乳腺癌女性群体中，保乳手术（breast-conserving surgery, BCS）联合内分泌治疗联合放疗，对比单纯内分泌治疗的真实世界成本效益。本研究从美国医疗保险与医疗补助服务中心的研究视角出发，设定8年的研究时限。成本（以2020年美元计价）与健康效用值（质量调整生命年，quality-adjusted life years, QALYs）分别来自与医疗保险数据库关联的监测、流行病学与最终结果（Surveillance, Epidemiology, and End Results, SEER）数据库，以及医疗保险健康结局调查的回顾性研究。本研究通过无偏双稳健估计量，估算保乳术后内分泌治疗联合放疗对比单纯内分泌治疗的增量成本效果比（incremental cost-effectiveness ratio, ICER）。采用Bootstrap自助法开展敏感性分析以估算可信区间。相较于保乳术后单纯内分泌治疗组（0.77个质量调整生命年，2028.58美元），保乳术后内分泌治疗联合放疗组可获得更高的临床获益（2.66个质量调整生命年）与治疗成本（19424.27美元）。本次研究估算的增量成本效果比为9174.94美元/质量调整生命年。敏感性分析未改变研究结果的结论方向。研究结果表明，在美国人群中，放疗联合内分泌治疗方案具备成本效益。