PURPOSE: To use 5 years of primary data to compare the incremental cost-effectiveness of breast conservation and radiation versus mastectomy with the restriction of choice to a single therapy versus providing a choice of either therapy. PATIENTS AND METHODS: We evaluated a random retrospective cohort of 2,517 Medicare beneficiaries treated for newly diagnosed stage I or II breast cancer from 1992 through 1994. The outcome measures were quality-adjusted life-years (QALYs) and 5-year medical costs. Risk and propensity score adjustments were used in the analysis. RESULTS: A breast conservation and radiation regimen has significantly higher costs than mastectomy in the first year after surgery; the adjusted 5-year costs are $14,054 (95% confidence interval, $9,791 to $18,312) greater than those of mastectomy. The adjusted incremental cost-effectiveness ratio comparing breast conservation and radiation to mastectomy was $219,594 per QALY for the comparison of the two strategies. If the possibility of patient choice from maintaining the availability of multiple treatments versus restricting choice to mastectomy alone provides a quality-of-life gain of 0.031 QALYs, then the cost-effectiveness ratio of this choice option is $80,440 per QALY. CONCLUSION: The current system of providing a choice between mastectomy and breast conservation surgery is economically attractive when the economic analysis includes the benefit of patient choice of treatment.
PURPOSE: To use 5 years of primary data to compare the incremental cost-effectiveness of breast conservation and radiation versus mastectomy with the restriction of choice to a single therapy versus providing a choice of either therapy. PATIENTS AND METHODS: We evaluated a random retrospective cohort of 2,517 Medicare beneficiaries treated for newly diagnosed stage I or II breast cancer from 1992 through 1994. The outcome measures were quality-adjusted life-years (QALYs) and 5-year medical costs. Risk and propensity score adjustments were used in the analysis. RESULTS: A breast conservation and radiation regimen has significantly higher costs than mastectomy in the first year after surgery; the adjusted 5-year costs are $14,054 (95% confidence interval, $9,791 to $18,312) greater than those of mastectomy. The adjusted incremental cost-effectiveness ratio comparing breast conservation and radiation to mastectomy was $219,594 per QALY for the comparison of the two strategies. If the possibility of patient choice from maintaining the availability of multiple treatments versus restricting choice to mastectomy alone provides a quality-of-life gain of 0.031 QALYs, then the cost-effectiveness ratio of this choice option is $80,440 per QALY. CONCLUSION: The current system of providing a choice between mastectomy and breast conservation surgery is economically attractive when the economic analysis includes the benefit of patient choice of treatment.
Authors: Fabian Tollens; Pascal A T Baltzer; Matthias Dietzel; Moritz L Schnitzer; Vincent Schwarze; Wolfgang G Kunz; Johann Rink; Johannes Rübenthaler; Matthias F Froelich; Stefan O Schönberg; Clemens G Kaiser Journal: Eur Radiol Date: 2022-04-28 Impact factor: 5.315
Authors: Scott Ramsey; Elizabeth Whitley; Victoria Warren Mears; June M McKoy; Rachel M Everhart; Robert J Caswell; Kevin Fiscella; Thelma C Hurd; Tracy Battaglia; Jeanne Mandelblatt Journal: Cancer Date: 2009-12-01 Impact factor: 6.860
Authors: Elvira Vos; Linetta Koppert; Winnifred van Lankeren; Cornelis Verhoef; Bas Groot Koerkamp; Myriam Hunink Journal: Qual Life Res Date: 2017-11-17 Impact factor: 4.147
Authors: Fabian Tollens; Pascal A T Baltzer; Matthias Dietzel; Moritz L Schnitzer; Wolfgang G Kunz; Johann Rink; Johannes Rübenthaler; Matthias F Froelich; Clemens G Kaiser Journal: Front Oncol Date: 2021-09-09 Impact factor: 6.244