Comparing costs of standard Breast-Conserving Surgery to Oncoplastic Breast-Conserving Surgery and Mastectomy with Immediate two-stage Implant-Based Breast Reconstruction. Issue 8 (August 2022)

• Record Type: Journal Article
• Authors: Witmer, Tom J.K.; Kouwenberg, Casimir A.E.; Bargon, Claudia A.; de Leeuw, Daniëlle M.; Koiter, Eveline; Siemerink, Ester J.M.; Mureau, Marc A.M.; Rakhorst, Hinne A.
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 75:Issue 8(2022)
• Page Start: 2569
• Page End: 2576
• Publication Date: 2022-08
• Subjects: Breast Cancer -- Breast-Conserving Surgery -- Oncoplastic Breast-Conserving Surgery -- Breast Reconstruction -- Costs -- Complications; ADM Acellular dermal matrix -- BCS Breast-conserving surgery -- C-BCS Conventional breast-conserving surgery -- M-IBR Mastectomy immediate breast reconstruction -- OP-BCS Oncoplastic breast-conserving surgery -- PROs Patient-Reported Outcomes -- ZGT Ziekenhuisgroep Twente -- DCIS Ductal carcinoma in situ -- BMI Body Mass Index -- NZa Nederlandse Zorgautoriteit (Dutch Health Care authority) -- SD Standard deviation -- IQR Interquartile range -- ERAS Enhanced Recovery After Surgery -- PORT Postoperative Radiotherapy -- QALY Quality Adjusted Life Years; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2022.02.050
• Languages: English
• ISSNs: 1748-6815

Abstract

Abstract: Background: Conventional breast-conserving surgery (C-BCS) has equal oncological outcomes and superior cosmetic and patient-reported outcomes compared to mastectomy with immediate two-stage implant-based breast reconstruction (M-IBR). Oncoplastic breast-conserving surgery (OP-BCS) is increasingly being used, as it often has better cosmetic results and it enables larger tumour resection. However, OP-BCS and M-IBR compared to C-BCS lengthens operative time and might lead to more complications and consequently to additional costs. Therefore, this study aimed to compare costs and complication rates of C-BCS, OP-BCS and M-IBR. Methods: This single-centre, retrospective cohort study, calculated costs for all patients who had undergone breast cancer surgery between January 2014 and December 2016. Patient-, tumour- and surgery-related data of C-BCS, OP-BCS and M-IBR patients were retrieved by medical record review. Treatment costs were calculated using hospital financial data. Differences in costs and complications were analysed. Results: A total of 220 patients were included: 74 patients in the C-BCS, 78 in the OP-BCS and 68 in the M-IBR group. From most expensive to least expensive, differences in total costs were found between C-BCS vs. OP-BCS and C-BCS vs. M-IBR (p=<0.01 and p=0.04, respectively). Costs of OP-BCS and M-IBR were comparable. Complication rates were 5.5% for C-BCS, followed by 17% for OP-BCS, and 34% for M-IBR (p<0.01). Conclusion: Considering total treatment costs, OP-BCS was financially non-inferior to M-IBR, whereas complication rates were higher following M-IBR. Therefore, when considering other benefits of OP-BCS, such as higher patient-reported outcomes and similar oncological outcomes, a shift from M-IBR to BCS using oncoplastic techniques seems justified.