Modelling study of deep inspiration breath-hold for breast cancer radiotherapy

Deep inspiration breath-hold (DIBH) holds promise in mitigating late cardiac and pulmonary toxicities in breast cancer patients; however, it increases resource demands, potentially compromising operational efficiency and access to radiotherapy (RT). A state-transitionn microsimulation model was developed to assess the cost-effectiveness of DIBH versus free breathing in Belgian women aged 40-79 years receiving RT with or without regional nodal irradiation for breast cancer. DIBH was cost-effective in 58.3% of patients, exhibiting more pronounced benefits in individuals with left-sided cancer, node positive disease, smokers, those with elevated baseline cardiovascular disease risk, and older age groups. Compared with not using DIBH, adopting DIBH universally led to a 21.7% (95% CI 21.2-22.2) decrease in maximum throughput, whereas a targeted approach (i.e. 58.3% DIBH) resulted in a 13.1% (12.9-14.0) reduction in maximun throughput. The authors conclude that a targeted RT approach priorities DIBH for those deriving the most benefit, improving RT resource utilization and supporting value-based healthcare.