Economic evaluation of radiotherapy for early breast cancer after breast-conserving surgery in a health resource-limited setting

The primary objective was to assess the cost-effectiveness, from the Chinese societal perspective, of additional radiotherapy for women with early breast cancer after breast-conserving surgery (BCS). The Markov model was constructed to simulate women's transitions across various health states based on the clinical course of breast cancer (no recurrence, local or distant recurrence, and death) and treatment strategy (radiotherapy vs. no-radiotherapy). The clinical and utility data were estimated from published studies. Costs were estimated from the perspective of Chinese society. Quality-adjusted life-years (QALYs) and incremental cost-effective ratios (ICERs) were determined. Probabilistic and one-way sensitivity analyses were performed. The addition of radiotherapy following BCS was associated with improved overall survival (22.20 vs. 19.51 years) and QALYs (13.25 vs. 11.75) and reduced lifetime costs ($24,518.9 vs. $25,147.0). The ICER of radiotherapy vs. no-radiotherapy was -$420.56/QALY gained. Sensitivity, subgroup and scenario analyses indicated that these results were robust against plausible assumptions and variations. In health resource-limited settings, the addition of radiotherapy is a very cost-effective strategy in comparison to no-radiotherapy in women with early breast cancer.