Patient-level costs in margin re-excision for breast-conserving surgery

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.