A cost-utility analysis comparing large volume displacement oncoplastic surgery to mastectomy with single stage implant reconstruction in the treatment of breast cancer |
| |
| Affiliation: | 1. Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States;2. Department of Surgery, Tufts University Medical Center, Boston, MA, United States;3. Department of Surgery, Indiana University, IN, United States;4. Department of Plastic Surgery, Emory University, GA, United States;1. Stanford University, Department of the School of Medicine, Stanford, CA, USA;2. Stanford University, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford, CA, USA;1. Department of Economics and Law, University of Macerata, Via Crescimbeni, 20, I-62100 Macerata, Italy;2. Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Via Conca 71, 60126 Ancona, Italy;1. Department of Surgical Sciences, Section of Plastic Surgery, Uppsala University, Uppsala University Hospital, Sweden;2. Department of Surgery, Capio S:t Görans Hospital, Stockholm, Sweden;3. Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Sweden;4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden;5. Department of Clinical Science and Education, Southern General Hospital, Stockholm, Sweden;6. Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden;7. Department of Breast and Melanoma Surgery, Skåne University Hospital, Malmö Lund, Sweden;8. Department of Hand Surgery and Plastic Surgery, Linköping University Hospital, Linköping, Sweden;9. Department of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska Akademin, Gothenburg, Sweden;10. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;11. Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden;1. Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln''s Inn Fields, London, WC2A 3PE, UK;2. Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy''s and St Thomas'' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK;3. Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP, UK;4. Department of Breast Surgery, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Romsey Road, Winchester, SO22 5DG, UK;5. Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK;1. Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia;2. Breast and Surgical Oncology at the Poche Centre, North Sydney, Australia;3. Academic Institute, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia;4. Royal North Shore and Mater Hospitals, Sydney, Australia;1. Tufts Medical Center, Department of Surgery, Boston, MA, USA;2. Tufts University School of Medicine, Boson, MA, USA |
| |
| Abstract: | ![]()
BackgroundFor larger cancers in moderate to large breast sized women, breast surgical cancer treatment may include large volume displacement oncoplastic surgery (LVOS) or mastectomy with single stage implant reconstruction (SSIR). Often in the case of LVOS, reduction mammaplasty designs are used in the oncoplastic reconstructions with a contralateral symmetry operation. The goal of this study was to investigate the cost-utility between LVOS versus SSIR to determine which approach is cost-effective in the treatment of breast cancer.MethodsA review of the literature was performed to determine baseline values and ranges. An average national Medicare payment rates using DRG and CPT codes were used for cost assessment. After constructing a decision tree, an incremental cost-utility ratio (ICUR) was calculated comparing the difference for both surgical options in costs by the difference in clinical-effectiveness. To validate our results, we performed one-way sensitivity analyses in addition to a Monte-Carlo analysis.ResultsAn ICUR of $546.81/QALY favoring LVOS was calculated based off of its clinical-effectiveness gain of 7.67 QALY at an additional cost of $4194. One-way sensitivity analyses underscored the degree by which LVOS was cost-effective. For example, LVOS became cost-ineffective when a successful LVOS cost more than $50,000. Similarly, probabilistic sensitivity analysis using Monte-Carlo simulation showed that even with varying multiple variables at once, results tended to favor our conclusion supporting the cost-effectiveness of LVOS.ConclusionsFor the appropriate patients with moderate to large sized breasts with breast cancer, large volume displacement oncoplastic surgery is cost-effective compared to mastectomy with single staged implant reconstruction. |
| |
| Keywords: | Breast Cancer Cost-utility analysis Mastectomy Reconstruction Implant |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
