Incremental Spending Associated with Low-Value Treatments in Older Women with Breast Cancer

Background In most women >= 70 years old with hormone-receptor-positive breast cancer, axillary staging and adjuvant radiotherapy provide no survival advantage over surgery and hormone therapy alone. Despite recommendations for their omission, sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy rates remain high. While treatment side effects are well documented, less is known about the incremental spending associated with SLNB and adjuvant radiotherapy. Methods Using a statewide multipayer claims registry, we examined spending associated with breast cancer treatment in a retrospective cohort of women >= 70 years old undergoing surgery. Results 9074 women >= 70 years old underwent breast cancer resection between 2012 and 2019, with 78% (n = 7122) receiving SLNB and/or adjuvant radiotherapy within 90 days of surgery. Women undergoing SLNB were more likely to receive radiation (51% vs. 28%; p < 0.001 and OR = 2.68). Average 90-day spending varied substantially based upon treatment received, ranging from US$10,367 (breast-conserving surgery alone) to US$27,370 (mastectomy with SLNB and adjuvant radiotherapy). The relative increases in 90-day treatment spending in the breast-conserving surgery cohort was 65% for SLNB, 82% for adjuvant radiotherapy, and 120% for both treatments. Conclusions SLNB and adjuvant radiotherapy have significant spending implications in older women with breast cancer, even though they are unlikely to improve survival.

Automated summary

For most women aged 70 and above with hormone-receptor-positive breast cancer, axillary staging and adjuvant radiotherapy do not provide a survival advantage over surgery and hormone therapy alone. Despite recommendations to omit these steps, rates of sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy remain high. These treatments have significant spending implications, with a substantial increase in treatment costs without clear survival benefits.