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Reoperations after breast-conserving surgery (BCS) for positive margins significantly increase patient costs. Optimizing initial BCS procedures can lead to substantial healthcare savings.

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Area of Science:

  • Oncology
  • Health Economics
  • Surgical Outcomes

Background:

  • High reoperation rates after breast-conserving surgery (BCS) for positive margins incur significant costs for healthcare providers.
  • Assessing the quality of evidence on re-excision costs is crucial for understanding the economic impact of BCS.
  • Direct patient-level costs for successful BCS versus reoperations require detailed comparison.

Purpose of the Study:

  • To evaluate the quality of existing evidence on the costs associated with re-excision after BCS.
  • To compare the direct patient-level costs between patients who underwent successful BCS and those requiring reoperation.
  • To identify potential cost savings by optimizing initial BCS procedures.

Main Methods:

  • A systematic review of health economic analyses in BCS was performed, with studies scored using the Quality of Health Economic Studies (QHES) instrument.
  • Patient data from women undergoing BCS with or without reoperation were analyzed using the Patient-Level Information and Costing Systems (PLICS).
  • Financial data were collected for a 12-month period, including initial lumpectomy and reoperation costs.

Main Results:

  • The median QHES score was 47, with only two of nine studies scoring in the upper quartile, indicating a general lack of high-quality cost studies.
  • The median cost of reoperations after BCS was £4511, an additional £2136 per patient compared to BCS without reoperation (P < 0.001).
  • Initial lumpectomy costs ranged from US$1234-11786, and reoperation costs ranged from US$655-9136.

Conclusions:

  • A paucity of high-quality studies exists regarding the cost of reoperations after BCS.
  • Significant additional costs are associated with reoperations following BCS.
  • Implementing strategies to ensure BCS is performed correctly the first time could yield substantial national healthcare savings.