Ammar Asban1, Christopher Homsy2, Lilian Chen2, Carla Fisher3, Albert Losken4, Abhishek Chatterjee5. 1. Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States. 2. Department of Surgery, Tufts University Medical Center, Boston, MA, United States. 3. Department of Surgery, Indiana University, IN, United States. 4. Department of Plastic Surgery, Emory University, GA, United States. 5. Department of Surgery, Tufts University Medical Center, Boston, MA, United States. Electronic address: chatterjeeac14@gmail.com.
Abstract
BACKGROUND: For larger cancers in moderate to large breast sized women, breast surgical cancer treatment may include large volume displacement oncoplastic surgery (LVOS) or mastectomy with single stage implant reconstruction (SSIR). Often in the case of LVOS, reduction mammaplasty designs are used in the oncoplastic reconstructions with a contralateral symmetry operation. The goal of this study was to investigate the cost-utility between LVOS versus SSIR to determine which approach is cost-effective in the treatment of breast cancer. METHODS: A review of the literature was performed to determine baseline values and ranges. An average national Medicare payment rates using DRG and CPT codes were used for cost assessment. After constructing a decision tree, an incremental cost-utility ratio (ICUR) was calculated comparing the difference for both surgical options in costs by the difference in clinical-effectiveness. To validate our results, we performed one-way sensitivity analyses in addition to a Monte-Carlo analysis. RESULTS: An ICUR of $546.81/QALY favoring LVOS was calculated based off of its clinical-effectiveness gain of 7.67 QALY at an additional cost of $4194. One-way sensitivity analyses underscored the degree by which LVOS was cost-effective. For example, LVOS became cost-ineffective when a successful LVOS cost more than $50,000. Similarly, probabilistic sensitivity analysis using Monte-Carlo simulation showed that even with varying multiple variables at once, results tended to favor our conclusion supporting the cost-effectiveness of LVOS. CONCLUSIONS: For the appropriate patients with moderate to large sized breasts with breast cancer, large volume displacement oncoplastic surgery is cost-effective compared to mastectomy with single staged implant reconstruction.
BACKGROUND: For larger cancers in moderate to large breast sized women, breast surgical cancer treatment may include large volume displacement oncoplastic surgery (LVOS) or mastectomy with single stage implant reconstruction (SSIR). Often in the case of LVOS, reduction mammaplasty designs are used in the oncoplastic reconstructions with a contralateral symmetry operation. The goal of this study was to investigate the cost-utility between LVOS versus SSIR to determine which approach is cost-effective in the treatment of breast cancer. METHODS: A review of the literature was performed to determine baseline values and ranges. An average national Medicare payment rates using DRG and CPT codes were used for cost assessment. After constructing a decision tree, an incremental cost-utility ratio (ICUR) was calculated comparing the difference for both surgical options in costs by the difference in clinical-effectiveness. To validate our results, we performed one-way sensitivity analyses in addition to a Monte-Carlo analysis. RESULTS: An ICUR of $546.81/QALY favoring LVOS was calculated based off of its clinical-effectiveness gain of 7.67 QALY at an additional cost of $4194. One-way sensitivity analyses underscored the degree by which LVOS was cost-effective. For example, LVOS became cost-ineffective when a successful LVOS cost more than $50,000. Similarly, probabilistic sensitivity analysis using Monte-Carlo simulation showed that even with varying multiple variables at once, results tended to favor our conclusion supporting the cost-effectiveness of LVOS. CONCLUSIONS: For the appropriate patients with moderate to large sized breasts with breast cancer, large volume displacement oncoplastic surgery is cost-effective compared to mastectomy with single staged implant reconstruction.
Authors: Charlotte Davies; Christopher Holcombe; Joanna Skillman; Lisa Whisker; William Hollingworth; Carmel Conefrey; Nicola Mills; Paul White; Charles Comins; Douglas Macmillan; Patricia Fairbrother; Shelley Potter Journal: BMJ Open Date: 2021-04-16 Impact factor: 2.692
Authors: Abhishek Chatterjee; Maurice Y Nahabedian; Allen Gabriel; Michael Sporck; Mousam Parekh; David Macarios; Jason Hammer; Steven Sigalove Journal: Plast Reconstr Surg Glob Open Date: 2021-10-26
Authors: Joshua A Bloom; Zachary Erlichman; Sina Foroutanjazi; Zhaneta Beqiraj; Michael M Jonczyk; Sarah M Persing; Abhishek Chatterjee Journal: Plast Reconstr Surg Glob Open Date: 2021-08-19