{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T14:35:03Z","timestamp":1777732503283,"version":"3.51.4"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["INQUIRY"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:p>\n                    A new breast cancer treatment, brachytherapy-based accelerated partial breast radiotherapy (RT), was adopted before long-term effectiveness evidence, potentially increasing morbidity and costs compared with whole breast RT. The aim of this study was to estimate complication rates and RT-specific and 1-year costs for a cohort of female Medicare beneficiaries diagnosed with breast cancer (N = 47 969). We analyzed 2005-2007 Medicare claims using multivariable logistic regression for complications and generalized linear models (log link, gamma distribution) for costs. Overall, 11% (n = 5296) underwent brachytherapy-based RT; 9.4% had complications. Odds of any complication were higher (odds ratio [OR]: 1.62; 95% confidence interval [CI]: 1.49-1.76) for brachytherapy versus whole breast RT, similarly to seroma (OR: 2.85; 95% CI: 1.97-4.13), wound complication\/infection (OR: 1.72; 95% CI: 1.52-1.95), cellulitis (OR: 1.48; 95% CI: 1.27-1.73), and necrosis (OR: 2.07; 95% CI: 1.55-2.75). Mean RT-specific and 1-year total costs for whole breast RT were $6375, and $19 917, $4886, and $4803 lower than brachytherapy (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; .0001). Multivariable analyses indicated brachytherapy yielded 76% higher RT costs (risk ratio: 1.76; 95% CI: 1.74-1.78,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; .0001) compared with whole breast RT. Brachytherapy had higher complications and costs before long-term evidence proved its effectiveness. Policies should require treatment registries with reimbursement incentives to capture surveillance data for new technologies.\n                  <\/jats:p>","DOI":"10.1177\/0046958018759115","type":"journal-article","created":{"date-parts":[[2018,3,5]],"date-time":"2018-03-05T04:30:21Z","timestamp":1520224221000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["New Breast Cancer Radiotherapy Technology Confers Higher Complications and Costs Before Effectiveness Proven: A Medicare Data Analysis"],"prefix":"10.1177","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5896-0499","authenticated-orcid":false,"given":"Heather T.","family":"Gold","sequence":"first","affiliation":[{"name":"NYU Langone Health, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn","family":"Walter","sequence":"additional","affiliation":[{"name":"NYU Langone Health, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleni","family":"Tousimis","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Katherine","family":"Hayes","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,3,5]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000215."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.1062."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa020989"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199306033282201"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2004.04.010"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011136326943"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2007.06.010"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.139.6.603"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)03811-7."},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.7436"},{"key":"e_1_3_2_12_2","unstructured":"American Society of Breast Surgeons. Consensus statement for accelerated partial breast irradiation. https:\/\/www.breastsurgeons.org\/new_layout\/about\/statements\/PDF_Statements\/APBI.pdf. Published 2011."},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.02.031"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.02.059."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djr495."},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.27.0942"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2013.01.168."},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.11.043"},{"key":"e_1_3_2_19_2","unstructured":"National Surgical Adjuvant Breast and Bowel Project Radiation Therapy Oncology Group. NSABP PROTOCOL B-39\/RTOG PROTOCOL 0413: a randomized Phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with Stage 0 I or II breast cancer. Date unknown. http:\/\/www.nsabp.pitt.edu\/B-39.asp."},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2008.09.016"},{"key":"e_1_3_2_21_2","unstructured":"Ontario Clinical Oncology Group. RAPID: randomized trial of accelerated partial breast irradiation. http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00282035?spons=%22Ontario+Clinical+Oncology+Group+%28OCOG%29%22&spons_ex=Y&rank=11. Published 2008. Accessed February 2018."},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.10110"},{"key":"e_1_3_2_23_2","unstructured":"Strnad V Polgar C eds. Interstitial brachytherapy alone versus external beam radiation therapy after breast conserving surgery for low risk invasive carcinoma and low risk duct carcinoma in-situ (DCIS) of the female breast. http:\/\/www.apbi.uni-erlangen.de\/outline\/outline.html. Published 2008. Accessed February 2018."},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23227"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.43.5297."},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.3481."},{"key":"e_1_3_2_27_2","unstructured":"Centers for Medicare and Medicaid Services. Chronic Condition Data Warehouse\u2014chronic condition algorithms. https:\/\/www.ccwdata.org\/web\/guest\/condition-categories Published Accessed February 8 2018."},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2007.03.011."},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2226."},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1198\/016214501753208582"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182363d64."},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2015.03.003."},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw178."},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X14541679."},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X14546378."}],"container-title":["INQUIRY: The Journal of Health Care Organization, Provision, and Financing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0046958018759115","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0046958018759115","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0046958018759115","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:05:20Z","timestamp":1777460720000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0046958018759115"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1]]},"references-count":34,"alternative-id":["10.1177\/0046958018759115"],"URL":"https:\/\/doi.org\/10.1177\/0046958018759115","relation":{},"ISSN":["0046-9580","1945-7243"],"issn-type":[{"value":"0046-9580","type":"print"},{"value":"1945-7243","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1]]},"article-number":"0046958018759115"}}