OBJECTIVES: Whole-breast external beam radiotherapy (WB-EBRT) is the standard of care in the UK among patients with early invasive breast cancer (BC) following breast-conserving surgery but is associated with short- and long-term adverse effects. The INTRABEAM^® device may be used to deliver adjuvant targeted intraoperative radiation therapy (TARGIT-IORT) to patients with early BC at the time of surgery, while reducing treatment-associated burden, resource utilization, and exposure to radiation and relevant toxicities. An economic evaluation was performed to assess the cost-effectiveness of INTRABEAM over a lifetime horizon, from a UK National Health Service (NHS) perspective.

METHODS: A Markov model was developed to estimate the long-term costs and effectiveness of INTRABEAM compared to WB-EBRT, among a patient population eligible for breast-conserving surgery. A six-state model structure was utilized to capture patient progression from recurrence-free to recurrent cancer health states, with breast and non-breast cancer-related mortality also modeled. Transition probabilities were informed by published literature, with parametric models used to estimate mortality based on patient-level data. The model was developed probabilistically to account for uncertainty in model parameters, with a Monte Carlo simulation performed. Incremental costs and quality-adjusted life-years (QALYs) were estimated, with results presented in the form of an incremental cost-effectiveness ratio (ICER).

RESULTS: Base-case results indicated that the INTRABEAM device would dominate WB-EBRT over a lifetime, resulting in cost savings (-£4,583; INTRABEAM = £4,821, WB-EBRT = £9,404) and QALY gains (0.53; INTRABEAM = 14.61, WB-EBRT = 14.08). Univariate sensitivity analysis indicated that the cost, and utility, associated with the ‘Distant Recurrence’ health state was the most impactful parameter on overall results.

CONCLUSIONS: This modeling study indicated that an innovative technology developed for the delivery of TARGIT-IORT (INTRABEAM) has the potential to improve clinical outcomes among patients with early BC undergoing surgery, while reducing costs to the UK NHS.