BACKGROUND: High rates of reoperation following breast-conserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported re-excision costs and compare the direct patient-level costs between patients undergoing successful BCS versus reoperations after BCS. METHODS: The study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the Patient-Level Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = £0·75, £1 = €1·14 and US $1 = €0·85. RESULTS: The median QHES score was 47 (i.q.r. 32·5-79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US $1234-11786 and $655-9136 respectively. Over a 12-month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was £4511 (range 1752-18 019), representing an additional £2136 per patient compared with BCS without reoperation (P < 0·001). CONCLUSION: The systematic review demonstrated variation in methodological approach to cost estimates and a paucity of high-quality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.
BACKGROUND: High rates of reoperation following breast-conserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported re-excision costs and compare the direct patient-level costs between patients undergoing successful BCS versus reoperations after BCS. METHODS: The study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the Patient-Level Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = £0·75, £1 = €1·14 and US $1 = €0·85. RESULTS: The median QHES score was 47 (i.q.r. 32·5-79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US $1234-11786 and $655-9136 respectively. Over a 12-month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was £4511 (range 1752-18 019), representing an additional £2136 per patient compared with BCS without reoperation (P < 0·001). CONCLUSION: The systematic review demonstrated variation in methodological approach to cost estimates and a paucity of high-quality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.
Authors: Ken Y Foo; Kyle Newman; Qi Fang; Peijun Gong; Hina M Ismail; Devina D Lakhiani; Renate Zilkens; Benjamin F Dessauvagie; Bruce Latham; Christobel M Saunders; Lixin Chin; Brendan F Kennedy Journal: Biomed Opt Express Date: 2022-05-12 Impact factor: 3.562
Authors: Jeffery M Chakedis; Annie Tang; Alison Savitz; Liisa L Lyon; Patricia E Palacios; Brooke Vuong; Maihgan A Kavanagh; Gillian E Kuehner; Sharon B Chang Journal: Ann Surg Oncol Date: 2022-07-29 Impact factor: 4.339
Authors: Daan G J Linders; Okker D Bijlstra; Laura C Fallert; Denise E Hilling; Ethan Walker; Brian Straight; Taryn L March; A Rob P M Valentijn; Martin Pool; Jacobus Burggraaf; James P Basilion; Alexander L Vahrmeijer; Peter J K Kuppen Journal: Mol Imaging Biol Date: 2022-08-24 Impact factor: 3.484
Authors: Yasmin Grant; Paul T R Thiruchelvam; Lana Kovacevic; Elias Mossialos; Ragheed Al-Mufti; Katy Hogben; Dimitri J Hadjiminas; Daniel R Leff Journal: BJS Open Date: 2022-05-02
Authors: E Heeg; M B Jensen; L R Hölmich; A Bodilsen; R A E M Tollenaar; A V Laenkholm; B V Offersen; B Ejlertsen; M A M Mureau; P M Christiansen Journal: Br J Surg Date: 2020-08-06 Impact factor: 6.939
Authors: Martha S Kedrzycki; Maria Leiloglou; Vadzim Chalau; Nicolas Chiarini; Paul T R Thiruchelvam; Dimitri J Hadjiminas; Katy R Hogben; Faiza Rashid; Rathi Ramakrishnan; Ara W Darzi; Daniel S Elson; Daniel R Leff Journal: Ann Surg Oncol Date: 2021-08-04 Impact factor: 5.344