A Cost-Utility Analysis Comparing Immediate Oncoplastic Surgery with Delayed Oncoplastic Surgery in Smoking Breast Cancer Patients

Bloom, Joshua A.; Asban, Ammar; Tian, Tina; Sekigami, Yurie; Losken, Albert; Chatterjee, Abhishek

doi:10.1245/s10434-020-09220-z

Cited by 12 publications

(19 citation statements)

References 42 publications

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“…3 This rising unmet demand is unfavourable from both an individual and societal perspective, contributing to the psychosocial hardships of breast cancer survivors 11 -14 and leading directly to increased health care costs for Canadians. 15 -18 With over a decade of multi-year wait times, this cohort of patients with breast cancer merit recognition of their suffering with resources justified to meet their reconstructive needs as hospitals’ restore health care services post-pandemic.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective

et al. 2021

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Background: The COVID-19 pandemic has led to unprecedented challenges and restrictions in surgical access across Canada, including for breast reconstructive services which are an integral component of comprehensive breast cancer care. We sought to determine how breast reconstructive services are being restricted, and what strategies may be employed to optimize the provision of breast reconstruction through a pan-Canadian evaluation from the providers’ perspective. Methods: This was a cross-sectional survey of Canadian plastic and reconstructive surgeons who perform breast reconstruction. The 33-item web-based questionnaire was developed by a pan-Canadian working group of breast reconstruction experts and disseminated via email to members of the Canadian Society of Plastic Surgery. The questionnaire queried respondents on the impact of the COVID-19 pandemic and associated restrictions on surgeons’ breast reconstruction practice patterns and opinions on strategies for resource utilization. Results: Responses were received from 49 surgeons, who reported practicing in 8 of 10 Canadian provinces. Restrictions on the provision of breast reconstructive procedures were most limited during the First Wave of the COVID-19 pandemic, where all respondents reported at least some reduction in capacity and more than a quarter reporting complete cessation. Average reported reduction in capacity ranged from 31% to 78% across all 3 waves. Autologous, delayed, and prophylactic reconstructions were most commonly restricted. Conclusion: This study provides a pan-Canadian impact assessment on breast reconstructive services during the COVID-19 pandemic from the providers’ perspective. To uphold the standards of patient-centred care, a unified approach to strategically reorganize health care delivery now and in the future is needed.

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Section: Discussionmentioning

confidence: 99%

“…Health economic research on IBR supports this, with IBR shown to be cheaper and more cost-effective than DBR. 16 -19…”

Section: Introductionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective

et al. 2021

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“…This approach has been previously described. 12 , 13 Both interventions (conservative management and debulking surgery) have the same categories of postoperative outcomes: successful (within 25% volume of unaffected arm) or unsuccessful (more than 25% larger than unaffected arm) with different probabilities. These event pathways and probabilities were obtained from a prospective institutional database.…”

Section: Methodsmentioning

confidence: 99%

“…Using the QALYs and costs in the decision tree, the incremental cost-utility ratio (ICUR) was then calculated using the formula below: An ICUR of less than $50,000 was used to deem an approach cost-effective. 12…”

Section: Incremental Cost-utility Ratiomentioning

confidence: 99%

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Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis

Bloom

Granoff

Karlsson

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Lymphedema is a chronic, debilitating disease that has been described as the largest breast cancer survivorship burden. Debulking surgery has been shown to improve extremity volume, improve patient quality of life, and decrease the incidence of cellulitis in the literature. This procedure is routinely covered in numerous other developed countries, yet it is still inconsistently covered in the United States. Methods: Extremity volumes from all patients who underwent debulking surgery of the upper extremity at two institutions between December 2017 and January 2020 with at least 12 months follow-up were included. Procedural costs were calculated using Medicare reimbursement data. Average utility scores were obtained for each health state using a visual analog scale, then converted to quality-adjusted life years. A decision tree was generated, and incremental cost-utility ratios were calculated. Sensitivity analyses were performed to evaluate our findings. Results: Debulking surgery is associated with a higher clinical effectiveness (quality-adjusted life year) of 27.05 compared to conservative management (23.34), with a relative cost reduction of $74,487. Rollback analysis favored debulking surgery as the cost-effective option compared to conservative management. The resulting negative incremental cost-utility ratio of −20,115.07 favored debulking surgery and indicated a dominant strategy. Conclusion: Our study supports the use of debulking surgery for the treatment of chronic lymphedema of the upper extremity.

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The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

De La Cruz Ku,

Camarlinghi,

Mallouh

et al. 2023

Journal of Surgical Oncology

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BackgroundObesity has nearly tripled in the last 50 years. During the last decades, oncoplastic breast surgery has become an important choice in the surgical treatment of breast cancer. An association exists between higher body mass index (BMI) and wound complications for major operations, but there is scarce literature on oncoplastic surgery. Hence, our aim was to compare the complication rates among patients who underwent oncoplastic surgery, stratified by BMI.MethodsPatient data were analyzed from the National Surgical Quality Improvement Program database (NSQIP) for oncoplastic breast procedures (2005–2020). Patients were stratified according to World Health Organization obesity classifications. Multivariate logistic regression was performed to assess risk factors for complications (overall, operative, and wound‐related).ResultsFrom a total of 6887 patients who underwent oncoplastic surgery, 4229 patients were nonobese, 1380 had Class 1 obesity (BMI: 30 to <35 kg/m2), 737 Class 2 obesity (BMI: 35 to <40 kg/m2), and 541 Class 3 obesity (BMI: ≥ 40 kg/m2). Greater operative time was found according to higher BMI (p < 0.001). Multivariate analysis adjusted for baseline characteristics showed that patients with obesity Class 2 (odds ratio [OR] = 1.51, 95% confidence interval [CI]: 1.03–2.23, p = 0.037) and 3 (OR = 1.87, 95% CI 1.24–2.83, p = 0.003) had increased risk of overall and wound complications compared with Nonobese patients. Comparing obese with nonobese patients, there were no differences in rates of deep SSI, organ/space SSI, pneumonia, reintubation, pulmonary embolism, deep vein thrombosis, urinary tract infection, stroke, bleeding, postoperative sepsis, length of stay, and readmission.ConclusionsOncoplastic surgery is a safe procedure for most patients. However, caution should be exercised when performing oncoplastic surgery for patients with Class 2 or 3 obesity (BMI ≥ 35 kg/m2), given there was a higher rate of overall and wound‐specific complications, compared with patients who were not obese or had Class 1 obesity.

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A Cost-Utility Analysis Comparing Immediate Oncoplastic Surgery with Delayed Oncoplastic Surgery in Smoking Breast Cancer Patients

Cited by 12 publications

References 42 publications

The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective

The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective

Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis

The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

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