PRS PSRC Podium Proofs 2016
Abhishek Chatterjee, MD, MBA,* Anaeze Offodile, II, MD,† Albert Losken, MD,‡ Roger Graham, MD,* Lilian Chen, MD,* Carla Fisher, MD,§ Brian Czerniekci, MD, PhD§
From the *Tufts Medical Center, Boston, Mass.; †Lahey Clinic, Burlington, Mass.; ‡Emory University, Atlanta, Ga.; and §University of Pennsylvania, Philadelphia, Pa.
PURPOSE: Scarce cost analysis exists comparing oncoplastic breast surgery (OBS) with standard lumpectomy (SL). Our goal was to perform a cost-utility analysis comparing OBS with SL for breast cancer in the large breasted patient.
METHODS: Cost-utility methodology involved a systematic literature review compiling outcomes and their probabilities for the treatment of unilateral breast cancer using either oncoplastic resection/reconstruction with contralateral symmetry operations or unilateral lumpectomy operations. Utility score surveys were used for each outcome to estimate quality-adjusted life years. Medicare payment data represented costs. A decision analysis tree and incremental cost-utility ratio analysis portrayed the more cost-effective strategy. Sensitivity analyses were performed.
RESULTS: The literature review noted that OBS led to fewer positive margins compared with the SL (10% vs 18%). Utility scores for a successful operation favored the OBS patients (92.6 vs 86.55) but for positive margins favored SL patients (74.2 vs 70.2). OBS costs more than SL ($6782.36 vs $2399.99). Decision tree analysis revealed that OBS was more cost-effective with an incremental cost-utility ratio of $2473.54/quality-adjusted life years. Sensitivity analysis noted that SL became cost-effective when obtaining a utility score for successful surgery of greater than 92.33 (vs its surveyed value of 86.55).
CONCLUSIONS: OBS in the large breasted patient provides a cost-effective treatment option when compared with SL and should be considered as a primary treatment option.