深吸气屏气 (DIBH) 是一种在左侧乳腺癌放疗期间减少心脏暴露的有效技术。尽管有好处，但成本考虑及其对工作流程的影响仍然是广泛采用的重大障碍。本研究旨在评估 DIBH 的成本效益，并将其与乳腺癌治疗中的自由呼吸 (FB) 的操作、财务和临床结果进行比较。使用 DIBH 和 FB 技术为 100 名左侧乳腺癌患者制定了治疗计划。计算每种技术的剂量测定数据，包括平均心脏剂量，并用于估计放射治疗的心脏毒性。基于 SCORE2（系统冠状动脉风险评估）算法的状态转换微观模拟模型预测了 DIBH 对心血管结局和质量调整生命年 (QALY) 的影响。成本是从提供商的角度使用时间驱动的基于活动的成本计算来计算的，并采用 40,000 欧元的支付意愿阈值进行成本效益评估。离散事件模拟模型评估了 DIBH 与 FB 对放疗工作流程中吞吐量和等待时间的影响。在基本案例场景中，DIBH 与绝对风险降低 1.72% 相关（95% CI：1.67%-1.76%） 20 年来，总心血管事件发生率为 0.69%（95% CI：0.67%-0.72%）。此外，预计 DIBH 在同一时间段内可为每位左侧乳腺癌患者提供 0.04 QALY 增量（95% CI：0.05-0.05）。然而，DIBH 增加了治疗时间，使最大可实现治疗量减少了 12.48%（95% CI：12.36%-12.75%），并使每个左侧乳腺癌患者的费用增加了 617 欧元（95% CI：615-619 欧元）。增量成本效益比为每 QALY 14,023 欧元。尽管投入了时间，DIBH 对比利时人口来说仍然具有成本效益。 DIBH 的日益普及可能有益于乳腺癌幸存者的长期心血管健康。© 2024 作者。

Deep inspiration breath hold (DIBH) is an effective technique for reducing heart exposure during radiotherapy for left-sided breast cancer. Despite its benefits, cost considerations and its impact on workflow remain significant barriers to widespread adoption.This study aimed to assess the cost-effectiveness of DIBH and compare its operational, financial, and clinical outcomes with free breathing (FB) in breast cancer treatment.Treatment plans for 100 patients with left-sided breast cancer were generated using both DIBH and FB techniques. Dosimetric data, including the average mean heart dose, were calculated for each technique and used to estimate the cardiotoxicity of radiotherapy. A state-transition microsimulation model based on SCORE2 (Systematic Coronary Risk Evaluation) algorithms projected the effects of DIBH on cardiovascular outcomes and quality-adjusted life-years (QALYs). Costs were calculated from a provider perspective using time-driven activity-based costing, applying a willingness-to-pay threshold of €40,000 for cost-effectiveness assessment. A discrete event simulation model assessed the impacts of DIBH vs FB on throughput and waiting times in the radiotherapy workflow.In the base case scenario, DIBH was associated with an absolute risk reduction of 1.72% (95% CI: 1.67%-1.76%) in total cardiovascular events and 0.69% (95% CI: 0.67%-0.72%) in fatal cardiovascular events over 20 years. Additionally, DIBH was estimated to provide an incremental 0.04 QALYs (95% CI: 0.05-0.05) per left-sided breast cancer patient over the same time period. However, DIBH increased treatment times, reducing maximum achievable throughput by 12.48% (95% CI: 12.36%-12.75%) and increasing costs by €617 per left-sided breast cancer patient (95% CI: €615-€619). The incremental cost-effectiveness ratio was €14,023 per QALY.Despite time investments, DIBH is cost-effective in the Belgian population. The growing adoption of DIBH may benefit long-term cardiovascular health in breast cancer survivors.© 2024 The Authors.