Hypofractionated Radiotherapy for Breast Cancer: Financial Risk and Expenditures in the U.S. 2008-2017: Expenditure of Hypofractionated Radiotherapy.

ABSTRACT Background : Rising cancer care expenditures and technological advancement of shorter radiotherapy regimens have drawn significant attention to the use of hypofractionated radiotherapy in clinical care. We examine the costs of hypofractionated (HF-WBI) compared to conventional whole breast irradiation (CF-WBI) in the U.S. and investigate the influences of patient characteristics and commercial insurance on HF-WBI use. Methods : In a retrospective study using private employer-sponsored insurance claims, a pooled cross-sectional evaluation of radiotherapy in patients with commercial insurance was performed from 2008-2017. The study population included female patients with early-stage breast cancer treated with lumpectomy and whole breast irradiation. Results : A total of 15,869 women received HF-WBI, and 59,328 received CF-WBI. HF-WBI use increased 2008-2017. Community-level factors like a higher proportion of college graduates and greater mixed racial composition were associated with increased HF-WBI use. Mean insurer-paid radiotherapy expenditures were significantly lower for HF-WBI vs. CF-WBI (adjusted difference $6,375, 95% CI $6,147–$6,603). Mean patient out-of-pocket expenditure for HF-WBI was $139 less than that of CF-WBI. Geographic variation existed across U.S. states in HF-WBI use (range: 9.6-36.2%) with no consistent relationship between HF-WBI use and corresponding average cost differences between HF-WBI and CF-WBI. Conclusions : If trends continue, HF-WBI will soon become the dominant form of radiation treatment in the U.S. Although HF-WBI represents significant savings to the health care system and individual patients, no evidence indicated that a financial disincentive had slowed adoption of HF-WBI. Therefore, multi-level approaches, including individuals, the community, and health policy, should be utilized to promote cost-effective cancer care. Significance : Innovations to policies on cost-effective radiotherapy treatment might consider non-financial incentives to promote HF-WBI use.