Comparing Costs: Does Extreme Oncoplastic Breast-Conserving Surgery Confer a Cost Benefit When Compared with Mastectomy and Reconstruction?

Publication Title

Annals of surgical oncology : the official journal of the Society of Surgical Oncology

Authors

Janelle-Cheri Millen, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Udai S Sibia, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Katherine M Jackson, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Stacey Stern, Department of Biostatistics, Saint John's Cancer Institute, Providence Health System, Santa Monica, CA, USA.Follow
Javier I Orozco, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Crystal E Fancher, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Janie Grumley, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow

Document Type

Article

Publication Date

7-10-2024

Keywords

Breast neoplasm; Cost-benefit analysis; Mastectomy; Oncoplastic breast-conserving; california; pni; sjci

Abstract

INTRODUCTION: Extreme oncoplastic breast-conserving surgery (eOBCS) describes the application of OBCS to patients who would otherwise need a mastectomy, and its safety has been previously described.

OBJECTIVE: We aimed to compare the costs of eOBCS and mastectomy.

METHODS: We reviewed our institutional database to identify breast cancer patients treated surgically from 2018 to 2023. We included patients with a large disease span (≥5 cm) and multifocal/multicentric disease. Patients were grouped by their surgical approach, i.e. eOBCS or mastectomy. The direct costs of care were determined and compared; however, indirect costs were not included.

RESULTS: Eighty-six patients met the inclusion criteria, 10 (11.6%) of whom underwent mastectomy and 76 (88.4%) who underwent eOBCS. Six mastectomy patients (60%) had reconstruction and 6 (60%) underwent external beam radiation therapy (EBRT). Reconstructions were completed in a staged fashion, and the mean cost of the index operation (mastectomy and tissue expander) was $17,816. These patients had one to three subsequent surgeries to complete their reconstruction, at a mean cost of $45,904. The mean cost of EBRT was $5542. Thirty-four eOBCS patients (44.7%) underwent 44 margin re-excisions, including 6 (7.9%) who underwent mastectomy. Sixty (78.9%) of the eOBCS patients had EBRT. The mean cost of their index operation was $6345; the mean cost of a re-excision was $3615; the mean cost of their mastectomies with reconstruction was $49,400; and the mean cost of EBRT was $6807. The cost of care for eOBCS patients remained lower than that for mastectomy patients, i.e. $17,318 versus $57,416.

CONCLUSION: eOBCS is associated with a lower cost than mastectomy and had a low conversion rate to mastectomy.

Area of Special Interest

Cancer

Area of Special Interest

Women & Children

Specialty/Research Institute

Oncology

Specialty/Research Institute

Obstetrics & Gynecology

Specialty/Research Institute

Surgery

DOI

10.1245/s10434-024-15711-0