Cost-Outcome of Radiotherapy for Local Control and Overall Survival Benefits in Breast Cancer

Purpose: Radiotherapy (RT) is an integral component in the treatment of breast cancer. The aims of this study were to estimate the cost per 5-year Local Control (LC) and Overall Survival (OS) benefits of the first course of RT, based on breast cancer stage, and the potential cost savings with adoption of the FAST-Forward protocol. Methods and Materials: All RT activities for breast cancer RT July 2017-June 2020 and their associated costs were consolidated together. The average cost of treatment course was calculated (average cost per fraction X average no. of fractions). Cost per outcome was estimated based on published gains in 5-year LC and OS with optimal use of radiotherapy. Results: 481 patients with breast cancer were analysed. The average cost per fraction was $285 AUD (148 pound GBP) for all stages. The average costs for 5-year LC and OS gain were $31,483 AUD (16 pound 392 GBP) and $235,435 AUD (122 pound 566 GBP) respectively for all stages. The estimated costs for 5-year LC outcomes were $29,675 AUD (15 pound 450 GBP), $34,675 AUD (18 pound 053 GBP) and $32,478 AUD (16 pound 910 GBP) for Stage I-III respectively. The estimated costs for 5-year OS were $455,909 AUD (237 pound 378 GBP), $532,727 AUD ( pound 277 375 GBP) and $60,717 AUD (31 pound 614 GBP) for Stage I-III respectively. 266 patients had characteristics that made them eligible for the FAST-Forward protocol. A cost saving of $2592-3864 AUD (1350-2012 pound GBP) per patient was estimated had these patients been treated with the protocol. Conclusions: The cost of RT for LC outcome is similar across stages. The greatest value for OS outcome was seen in patients with Stage III breast cancer, due to the greater survival benefit with RT in these patients compared with Stage I-II breast cancer. Significant cost savings can be made by implementing the FAST- Forward protocol. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).