Can the Adoption of Hypofractionation Guidelines Expand Global Radiotherapy Access? An Analysis for Breast and Prostate Radiotherapy

Abstract

PURPOSE The limited radiotherapy resources for global cancer control have resulted in increased interest in developing time- and cost-saving innovations to expand access to those resources. Hypofractionated regimens could minimize cost and increase access for limited-resource countries. In this investigation, we estimated the percentage cost-savings per radiotherapy course and increased radiotherapy access in African countries after adopting hypofractionation for breast and prostate radiotherapy. For perspective, results were compared with high-income countries. METHODS The cost and course of breast and prostate radiotherapy for conventional and hypofractionated regimens in low-resource facilities were calculated using the Radiotherapy Cost Estimator tool developed by the International Atomic Energy Agency (IAEA) and then compared with another activity-based costing model. The potential maximum cost savings in each country over 7 years for breast and prostate radiotherapy were then estimated using cancer incidence data from the Global Cancer Observatory database with use rates applied. The increase in radiotherapy access was estimated by current national capacities from the IAEA directory. RESULTS The estimated cost per course of conventional and hypofractionated regimens were US$2,232 and $1,339 for breast treatment, and $3,389 and $1,699 for prostate treatment, respectively. The projected potential maximum cost savings with full hypofractionation implementation were $1.1 billion and $606 million for breast and prostate treatment, respectively. The projected increase of radiotherapy access due to implementing hypofractionation varied between +0.3% to 25% and +0.4% to 36.0% for breast and prostate treatments, respectively. CONCLUSION This investigation demonstrates that adopting hypofractionated regimens as standard treatment of breast and prostate cancers can result in substantial savings and increase radiotherapy access in developing countries. Given reduced delivery cost and treatment times, we anticipate a substantial increase in radiotherapy access with additional innovations that will allow progressive hypofractionation without compromising quality.

Cancer and COVID-19 Experiences at African Cancer Centers: The Silver Lining

“…In addition, hypofractionated radiation therapy in many instances should become the standard, decreasing cost and increasing patient convenience while maintaining value in cancer care as shown in a recent study. 19 Fixing infrastructure issues is a long-term challenge that COVID-19 has highlighted. We also acknowledge, despite sharing these experiences, that there is a lack of data on cancer mortality rates during the COVID-19 era, which can provide more perspective compared with prepandemic levels.…”

Hypofractionated versus conventional fractionated radiotherapy for breast cancer in patients with reconstructed breast: Toxicity analysis

“…In particular, hypofractionated RT had similar incidence in acute toxicity such as major wound problems, and late sequelae like flap contracture occurred rather less. In addition, in terms of convenience, hypofractionation resulted in higher patient satisfaction, due to the shorter overall duration and reduced cost of hypofractionated RT compared to conventional fractionated RT [ 13 , 14 ]. Therefore, hypofractionated RT has been gradually replacing conventional fractionated RT as a standard of care [ 11 ].Therefore, our results might support the selection of hypofractionated RT in the real world, even considering safety as well as cost-effectiveness.…”

“…If hypofractionated RT has complication rates that are comparable to conventional fractionated RT, it may become the standard treatment for patients with reconstructed breast cancer. Hypofractionation can be beneficial for patients because it can J o u r n a l P r e -p r o o f reduce the number of visits and the total cost of treatment (13,14). Therefore, this study aimed to identify any difference in breast-related complications between hypofractionated and conventional fractionated RT in breast cancer patients undergoing breast reconstruction.…”

Cost-effectiveness of postmastectomy hypofractionated radiation therapy vs conventional fractionated radiation therapy for high-risk breast cancer

“…The first large RCT offered high-level evidence supporting the noninferior efficacy of postmastectomy HFRT vs CFRT in women with high-risk breast cancer [12]. Generally, if there is no difference in efficacy and toxicities between different fractionated modalities, the reduced fractionation by HFRT in a large cohort of patients can result in substantial savings and increased radiation therapy access [37]. Previous studies have reported that the clinical use of HFRT instead of CFRT after breast-conserving surgery can significantly reduce direct medical costs based on the Medicare paying system in the USA [28,38].…”