Contralateral Prophylactic Mastectomy with Immediate Breast Reconstruction Increases Healthcare Utilization and Cost

Abstract

BM + IBR (autologous or implant) was associated with increased ER visits and higher total cost of care over 2 years compared with UM + IBR. Patients considering CPM should be counseled on the additional risks and costs associated with BM + IBR.

Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

“…Another important decision facing patients after mastectomy is whether to undergo unilateral or bilateral reconstruction. Despite the rise in risk for complications and health care use costs, 22,23 more patients are electing to undergo contralateral prophylactic mastectomy for unilateral breast cancer, especially in the setting of immediate breast reconstruction. [24][25][26] In addition to concern for contralateral malignant neoplasms and anxiety, another reason women cite for undergoing contralateral prophylactic mastectomy is the desire for symmetry, 27 which can have a significant association with patient-reported outcomes, especially satisfaction with the breast, as our findings suggest.…”

The effect of contralateral prophylactic mastectomy on breast‐related charges: A 5‐year analysis

“…The costs of UM vs BM with and without reconstruction have been reported in several other studies, some of which have been discussed here . To our knowledge, this is the first study to report a representation of costs associated with mastectomy decision making for the treatment of early‐stage UBC within a single healthcare system with a stable population of patients receiving virtually all aspects of their care and treatment within the system, including cancer treatment, imaging surveillance, outpatient follow‐up, and other breast‐related care.…”

“…This is in contrast to those studies from large, tertiary medical centers that may represent a subset of healthcare systems where patients travel to receive their initial cancer treatment but receive long‐term care nearer to their homes . Further, the cost analysis presented here is based on actual physician and hospital charge data as opposed to those studies reporting data generated more indirectly from a single payer class or from statistical modeling based on assumptions . For example, Boughey et al 14 looked at a larger population, over 11 000 women, but used claims data from a large commercial insurance database and did not include patients covered by government payers.…”

“…Presently, the data to suggest that BM either reduces costs (eg, less screening and decreased contralateral breast cancer incidence) or increases costs (eg, more surgery and increased morbidity) is inconsistent and imperfect . This study provides a comparison of immediate and subsequent charges attributed to the treatment and follow‐up for UBC.…”

Why women with an average risk for breast cancer undergo contralateral breast mastectomy? Does healthcare coverage matter?

“…There are also concerns regarding incurring higher short‐term healthcare cost compared to savings in reduction in long‐term surveillance costs. The increased cost for CMP and the follow‐up reconstructive surgery is the reason that these patients belonging to a higher sociodemographic status tend to choose this option at higher rate 21–23 …”