Unilateral versus Bilateral Mastectomy and Reconstruction: A 1- and 5-Year Cost Analysis
Jesse R. Smith, MD, MS1, Jennifer Jaffe, MPH, CCRP2, Jaclyn Pruitt, MA, CCRP2, Katharine Yao, MD2, Mark Sisco, MD3, Kristine Kuchta, MS4, Chi Ed Wang, PhD4, Michael A. Howard, MD3.
1Section of Plastic Surgery, University of Chicago Medicine & Biological Sciences, Chicago, IL, USA, 2Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA, 3Division of Plastic Surgery, NorthShore University HealthSystem, Evanston, IL, USA, 4Biostatistics and Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA.
PURPOSE: The purpose of this study was to determine costs following unilateral mastectomy (UM) and bilateral mastectomy (BM) for patients with unilateral breast cancer (UBC). We hypothesized that BM may be associated with fewer costs over time.
METHODS: A retrospective review was conducted of UBC patients treated between 2006 and 2010 with UM and BM in a large healthcare system. Institutional billing data was investigated for 5 years postoperatively to determine the immediate and subsequent charges of all breast-related care associated with the initial diagnosis.
RESULTS: During the study period, 450 subjects undergoing UM (n=286) or BM (n=164) were eligible for review. At 1 year, physician charges were significantly lower following UM versus BM (median $26,399 vs. $36,367; p<0.0001), and there was a trend toward lower hospital (median $88,427 vs. $96,412; p=0.9509) and total (median $125,230 vs. $138,467; p=0.6075) charges in this group as well. However, during years 2-5, physician (median $6,030 vs. $3,322; p=0.0338), hospital (median $14,596 vs. $8,019; p=0.0023) and total (median $22,128 vs. $13,478; p=0.0116) charges were significantly higher following UM (Table 1).
CONCLUSIONS: Charges following UM at 1 year were lower as compared to BM. However, the UM group experienced higher charges during years 2-5. It is essential to explore this topic further given that information on costs is valuable to patients and may exhibit some influence on the decision-making process.
Table 1. Short-term and long-term physician and hospital charges by mastectomy type after propensity score matching.
|Unilateral (n=160)||Bilateral (n=160)|
|Charges (2015 USD)||Median||IQR||Median||IQR||p-value|
IQR, interquartile range
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