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A Cost-utility Analysis Comparing Oncoplastic Breast Surgery to Standard Lumpectomy in Large Breasted Women
Abhishek Chatterjee, MD, MBA1, Anaeze Offodile II, MD2, Albert Losken, MD3, Roger Graham, MD1, Lilian Chen, MD1, Carla Fisher, MD4, Brian Czerniekci, MD, PhD4.
1Tufts Medical Center, Boston, MA, USA, 2Lahey Clinic, Burlington, MA, USA, 3Emory University, Atlanta, GA, USA, 4University of Pennsylvania, Philadelphia, PA, USA.

PURPOSE:
Scarce cost analysis exists comparing oncoplastic breast surgery (OBS) to standard lumpectomy (SL). Our goal was to perform a cost-utility analysis comparing OBS to SL for breast cancer in the large breasted patient.
METHODS:
Cost-utility methodology involved a systematic literature review compiling outcomes and their probabilities for the treatment of unilateral breast cancer using either oncoplastic resection/reconstruction with contralateral symmetry operations or unilateral lumpectomy operations. Utility score surveys were used for each outcome in order to estimate quality adjusted life years (QALYs). Medicare payment data represented costs. A decision analysis tree and incremental cost-utility ratio (ICUR) analysis portrayed the more cost-effective strategy. Sensitivity analyses were performed.
RESULTS:
The literature review noted that OBS led to fewer positive margins compared to the SL (10% versus 18%). Utility scores for a successful operation favored the OBS patients (92.6 versus 86.55) but for positive margins favored SL patients (74.2 versus 70.2). OBS costs more than SL ($6,782.36 versus $2399.99). Decision tree analysis (Figure 1) revealed that OBS was more cost-effective with an ICUR of $2473.54/QALY. Sensitivity analysis noted SL became cost-effective when obtaining a utility score for successful surgery of greater than 92.33 (versus its surveyed value of 86.55).
CONCLUSION:
Oncoplastic breast surgery in the large breasted patient provides a cost-effective treatment option when compared to standard lumpectomy and should be considered as a primary treatment option.


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