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Deep Inspiration Breath Hold in Left-Sided Breast Radiotherapy: A Balance Between Side Effects and Costs. | LitMetric

Deep Inspiration Breath Hold in Left-Sided Breast Radiotherapy: A Balance Between Side Effects and Costs.

JACC CardioOncol

Research Centre on Digital Medicine, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.

Published: August 2024

AI Article Synopsis

  • Deep Inspiration Breath Hold (DIBH) effectively reduces heart exposure during radiotherapy for left-sided breast cancer but faces challenges like cost and workflow disruptions.
  • A study found that DIBH decreased cardiovascular risks and improved quality-adjusted life-years (QALYs) but also increased treatment times and costs compared to free breathing (FB).
  • The cost-effectiveness ratio for DIBH was €14,023 per QALY, suggesting it might be a viable option despite higher expenses and longer treatment sessions.

Article 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.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372305PMC
http://dx.doi.org/10.1016/j.jaccao.2024.04.009DOI Listing

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