Cost-minimization analysis: should partial breast irradiation be utilized over whole breast irradiation assuming equivalent clinical outcomes?

Introduction: External beam partial breast irradiation (EB-PBI) is being used more frequently as an alternative to whole breast irradiation (WBI) in the adjuvant treatment of early-stage breast cancer. Breast cancer represents a substantial proportion of the workload for cancer centres; therefore, EB-PBI represents a possible alternative treatment of equal effectiveness that can have a significant impact on costs and patient throughput. However, planning this therapy requires increased quality assurance and resource allocation. Therefore, a cost minimization analysis was performed to compare WBI versus EB-PBI. Based on this study, recommendations on appropriate resource allocation and cost of resources at each step of planning can be made to maximize cost efficiency. Materials and Methods: Cost minimization requires a detailed determination of resource utilization for each of the two treatments. Activity-based costing was used to create a model of radiotherapy costs. A process map was developed that separated the management of patients into differentiated quantifiable units (dosimetry, QA, active treatment, other preparatory work). Time, labour costs, and capital costs were measured using interviews and validated with timed analyses. The perspective of the analysis was that of the hospital budget at a comprehensive cancer clinic in Canada. Thus, personal patient costs and radiation oncologist labour costs were not included in the analysis as these are not funded by the hospital budget. The WBI regimen was 50.0Gy in 2.0Gy fractions, taking place over five weeks. The EB-PBI was 38.5Gy in 3.85Gy fractions twice per day for five days. The two treatment arms are considered to have equivalent clinical outcomes. Results: The total costs per patient for WBI and EB-PBI were 1346.20 Canadian dollars (2012) and 1128.70 Canadian dollars, respectively. The capital costs per patient for WBI and EB-PBI were 937.50 Canadian dollars and 721.88 Canadian dollars, respectively. Labour costs accounted for 30% of WBI and 36% of EB-PBI. EB-PBI was 19% less expensive than WBI. Per patient, this is a cost difference of $217.50, or savings of $21,562.50 based on the department workload of 100 breast cancer patients per linear particle accelerator per year. The majority of the cost differences arose from both capital and labour costs needed for the extra fractions per patient required for WBI. Conclusions: EB-PBI significantly minimizes costs in the treatment of early-stage breast cancer relative to WBI. These results may be utilized by other institutions with other similar health care systems when executing decisions regarding resource allocation in the context of early-stage breast cancer treatment. Costs can be adjusted for each activity within the model. In addition, changes in operating parameters can be adjusted allowing other centres to determine detailed cost impacts specific to their own centre. The model can also be applied to different disease treatment methods.

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