PURPOSE: Contralateral prophylactic mastectomy (CPM) rates in women with unilateral breast cancer are increasing despite controversy regarding survival advantage. Current scrutiny of the medical costs led us to evaluate the cost-effectiveness of CPM versus routine surveillance as an alternative contralateral breast cancer (CBC) risk management strategy. METHODS: Using a Markov model, we simulated patients with breast cancer from mastectomy to death. Model parameters were gathered from published literature or national databases. Base-case analysis focused on patients with average-risk breast cancer, 45 years of age at treatment. Outcomes were valued in quality-adjusted life-years (QALYs). Patients' age, risk level of breast cancer, and quality of life (QOL) were varied to assess their impact on results. RESULTS: Mean costs of treatment for women age 45 years are comparable: $36,594 for the CPM and $35,182 for surveillance. CPM provides 21.22 mean QALYs compared with 20.93 for surveillance, resulting in an incremental cost-effectiveness ratio (ICER) of $4,869/QALY gained for CPM. To prevent one CBC, six CPMs would be needed. CPM is no longer cost-effective for patients older than 70 years (ICER $62,750/QALY). For BRCA-positive patients, CPM is clearly cost-effective, providing more QALYs while being less costly. In non-BRCA patients, cost-effectiveness of CPM is highly dependent on assumptions regarding QOL for CPM versus surveillance strategy. CONCLUSION: CPM is cost-effective compared with surveillance for patients with breast cancer who are younger than 70 years. Results are sensitive to BRCA-positive status and assumptions of QOL differences between CPM and surveillance patients. This highlights the importance of tailoring treatment for individual patients.
PURPOSE: Contralateral prophylactic mastectomy (CPM) rates in women with unilateral breast cancer are increasing despite controversy regarding survival advantage. Current scrutiny of the medical costs led us to evaluate the cost-effectiveness of CPM versus routine surveillance as an alternative contralateral breast cancer (CBC) risk management strategy. METHODS: Using a Markov model, we simulated patients with breast cancer from mastectomy to death. Model parameters were gathered from published literature or national databases. Base-case analysis focused on patients with average-risk breast cancer, 45 years of age at treatment. Outcomes were valued in quality-adjusted life-years (QALYs). Patients' age, risk level of breast cancer, and quality of life (QOL) were varied to assess their impact on results. RESULTS: Mean costs of treatment for women age 45 years are comparable: $36,594 for the CPM and $35,182 for surveillance. CPM provides 21.22 mean QALYs compared with 20.93 for surveillance, resulting in an incremental cost-effectiveness ratio (ICER) of $4,869/QALY gained for CPM. To prevent one CBC, six CPMs would be needed. CPM is no longer cost-effective for patients older than 70 years (ICER $62,750/QALY). For BRCA-positive patients, CPM is clearly cost-effective, providing more QALYs while being less costly. In non-BRCA patients, cost-effectiveness of CPM is highly dependent on assumptions regarding QOL for CPM versus surveillance strategy. CONCLUSION: CPM is cost-effective compared with surveillance for patients with breast cancer who are younger than 70 years. Results are sensitive to BRCA-positive status and assumptions of QOL differences between CPM and surveillance patients. This highlights the importance of tailoring treatment for individual patients.
Authors: Janie M Lee; Pamela M McMahon; Chung Y Kong; Daniel B Kopans; Paula D Ryan; Elissa M Ozanne; Elkan F Halpern; G Scott Gazelle Journal: Radiology Date: 2010-03 Impact factor: 11.105
Authors: Min Yi; Funda Meric-Bernstam; Lavinia P Middleton; Banu K Arun; Isabelle Bedrosian; Gildy V Babiera; Rosa F Hwang; Henry M Kuerer; Wei Yang; Kelly K Hunt Journal: Cancer Date: 2009-03-01 Impact factor: 6.860
Authors: Katja Goldflam; Kelly K Hunt; Jeffrey E Gershenwald; S Eva Singletary; Nadeem Mirza; Henry M Kuerer; Gildy V Babiera; Frederick C Ames; Merrick I Ross; Barry W Feig; Aysegul A Sahin; Banu Arun; Funda Meric-Bernstam Journal: Cancer Date: 2004-11-01 Impact factor: 6.860
Authors: Michael E Stokes; David Thompson; Eduardo L Montoya; Milton C Weinstein; Eric P Winer; Craig C Earle Journal: Value Health Date: 2008 Mar-Apr Impact factor: 5.725
Authors: Kelly Metcalfe; Henry T Lynch; Parviz Ghadirian; Nadine Tung; Ivo Olivotto; Ellen Warner; Olufunmilayo I Olopade; Andrea Eisen; Barbara Weber; Jane McLennan; Ping Sun; William D Foulkes; Steven A Narod Journal: J Clin Oncol Date: 2004-06-15 Impact factor: 44.544
Authors: Natalie B Jones; John Wilson; Linda Kotur; Julie Stephens; William B Farrar; Doreen M Agnese Journal: Ann Surg Oncol Date: 2009-06-09 Impact factor: 5.344
Authors: Oluwadamilola Motunaryo Fayanju; Carolyn R T Stoll; Susan Fowler; Graham A Colditz; Julie A Margenthaler Journal: Ann Surg Date: 2014-12 Impact factor: 12.969
Authors: Charlotte Gamble; Laura J Havrilesky; Evan R Myers; Junzo P Chino; Scott Hollenbeck; Jennifer K Plichta; P Kelly Marcom; E Shelley Hwang; Noah D Kauff; Rachel A Greenup Journal: Ann Surg Oncol Date: 2017-07-11 Impact factor: 5.344
Authors: Rachel C Hooper; Jessica Hsu; Anthony Duncan; Jessica M Bensenhaver; Lisa A Newman; Kelly M Kidwell; Kevin C Chung; Adeyiza O Momoh Journal: Plast Reconstr Surg Date: 2019-05 Impact factor: 4.730
Authors: Reshma Jagsi; Jing Jiang; Adeyiza O Momoh; Amy Alderman; Sharon H Giordano; Thomas A Buchholz; Steven J Kronowitz; Benjamin D Smith Journal: J Clin Oncol Date: 2014-02-18 Impact factor: 44.544
Authors: Ashish A Deshmukh; Scott B Cantor; Melissa A Crosby; Wenli Dong; Yu Shen; Isabelle Bedrosian; Susan K Peterson; Patricia A Parker; Abenaa M Brewster Journal: Ann Surg Oncol Date: 2014-05-09 Impact factor: 5.344