Financial Improvements From Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared With Standard of Care, "SAVE" Trial

Cristina DeCesaris; Trevor Wilson; Jaewhan Kim; Lindsay Burt; Jonathan Grant; Matthew M Harkenrider; Jessica Huang; Anuja Jhingran; Elizabeth Kidd; Andre Konski; Lilie Lin; William Small Jr; Gita Suneja; David Gaffney

doi:10.1016/j.prro.2024.07.006

Financial Improvements From Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared With Standard of Care, "SAVE" Trial

Pract Radiat Oncol. 2024 Sep 12:S1879-8500(24)00203-0. doi: 10.1016/j.prro.2024.07.006. Online ahead of print.

Authors

Affiliations

¹ Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. Electronic address: cristina.decesaris@hci.utah.edu.
² Department of Medicine, University of Wisconsin, Madison, Wisconsin.
³ Department of Economics, University of Utah, Salt Lake City, Utah.
⁴ Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
⁵ Department of Radiation Oncology, Intermountain Medical Center, Intermountain Health Care, Murray, Utah.
⁶ Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, Illinois.
⁷ Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, University of Texas, Houston, Texas.
⁸ Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, California.
⁹ Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

PMID: 39269405
DOI: 10.1016/j.prro.2024.07.006

Abstract

Purpose: Early-stage endometrial cancer is often treated with hysterectomy followed by adjuvant vaginal cuff brachytherapy (VCB). Financial toxicity from cancer treatment can impact treatment completion. The Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared to Standard of Care trial is a multicenter, prospective randomized trial of standard of care (SoC) VCB doses delivered in 3 to 5 fractions per the physician's discretion compared with a 2-fraction course. We report on secondary cost endpoints, quantifying the financial impacts of shorter treatment courses on institutions and participating patients.

Methods and materials: Technical (TechCs), professional, and total charges (TotCs) were collected prospectively and are reported as raw and Medicare-adjusted charges per patient. Distance to the treatment center and the median income for each patient's zip code were estimated. The Mann-Whitney U statistic, t test, and X² test were used to compare characteristics between the 2 groups.

Results: One hundred eight patients were analyzed. SoC VCB was delivered in 3, 4, and 5 fractions for 27 of 54 patients (50%), 11 of 54 (20%), and 16 of 54 (30%), respectively. The median total distance traveled per patient for SoC versus experimental arms was 213 versus 137 miles (p = .12), and the median cost of commute for patients was $36.3 versus $18.0 (p = .11). Compared with 2-fraction treatment, 5-fraction treatment resulted in longer travel distances (median, 462 vs 137 miles; p < .01) and increased travel costs (median, $59.3 vs $18.0; p ≤ .01). Unadjusted raw professional charges in USD per patient did not differ between SoC versus experimental arms ($9159 vs $7532; p = .19). TechCs were significantly higher in the SoC arm ($35,734 vs $24,696; p ≤ .01), as were TotCs ($44,892 vs $32,228; p < .01;). Medicare-adjusted TechCs and TotCs were higher for the SoC arm.

Conclusions: Two-fraction VCB resulted in fewer treatments per patient, reduced cost of travel compared with longer courses, and an adjusted reduction in health care expenditures compared with SoC.