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Deep Inspiration Breath Hold in Left-Sided Breast Radiotherapy: A Balance Between Side Effects and Costs.
Busschaert, Sara-Lise; Kimpe, Eva; Gevaert, Thierry; De Ridder, Mark; Putman, Koen.
Afiliación
  • Busschaert SL; Research Centre on Digital Medicine, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.
  • Kimpe E; Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
  • Gevaert T; Research Centre on Digital Medicine, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.
  • De Ridder M; Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
  • Putman K; Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
JACC CardioOncol ; 6(4): 514-525, 2024 Aug.
Article en En | MEDLINE | ID: mdl-39239337
ABSTRACT

Background:

Deep inspiration breath hold (DIBH) is an effective technique for reducing heart exposure during radiotherapy for left-sided breast cancer. Despite its benefits, cost considerations and its impact on workflow remain significant barriers to widespread adoption.

Objectives:

This study aimed to assess the cost-effectiveness of DIBH and compare its operational, financial, and clinical outcomes with free breathing (FB) in breast cancer treatment.

Methods:

Treatment plans for 100 patients with left-sided breast cancer were generated using both DIBH and FB techniques. Dosimetric data, including the average mean heart dose, were calculated for each technique and used to estimate the cardiotoxicity of radiotherapy. A state-transition microsimulation model based on SCORE2 (Systematic Coronary Risk Evaluation) algorithms projected the effects of DIBH on cardiovascular outcomes and quality-adjusted life-years (QALYs). Costs were calculated from a provider perspective using time-driven activity-based costing, applying a willingness-to-pay threshold of €40,000 for cost-effectiveness assessment. A discrete event simulation model assessed the impacts of DIBH vs FB on throughput and waiting times in the radiotherapy workflow.

Results:

In the base case scenario, DIBH was associated with an absolute risk reduction of 1.72% (95% CI 1.67%-1.76%) in total cardiovascular events and 0.69% (95% CI 0.67%-0.72%) in fatal cardiovascular events over 20 years. Additionally, DIBH was estimated to provide an incremental 0.04 QALYs (95% CI 0.05-0.05) per left-sided breast cancer patient over the same time period. However, DIBH increased treatment times, reducing maximum achievable throughput by 12.48% (95% CI 12.36%-12.75%) and increasing costs by €617 per left-sided breast cancer patient (95% CI €615-€619). The incremental cost-effectiveness ratio was €14,023 per QALY.

Conclusions:

Despite time investments, DIBH is cost-effective in the Belgian population. The growing adoption of DIBH may benefit long-term cardiovascular health in breast cancer survivors.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: JACC CardioOncol Año: 2024 Tipo del documento: Article País de afiliación: Bélgica Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: JACC CardioOncol Año: 2024 Tipo del documento: Article País de afiliación: Bélgica Pais de publicación: Estados Unidos