Cost analysis of re-excisions for breast conserving surgery in Central Texas.

Arora, Divya; Hasan, Syed; Male, Eneida; Abid, Raja; Ord, Celine Bicquart; Dauway, Emilia L.

doi:10.1200/jco.2015.33.15_suppl.e11534

Cited by 9 publications

(9 citation statements)

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“…In addition, 6 studies of the economic outcomes of the SSO-ASTRO guideline were eligible for narrative synthesis. All studies were undertaken in North America (5 in the US, and 1 in Canada) and included institutional cost estimates (n = 4) and decision analytic modeling (n = 2) . Five studies were full-text publications, and 1 was reported as a conference abstract …”

Section: Resultsmentioning

confidence: 99%

Changes in Reoperation After Publication of Consensus Guidelines on Margins for Breast-Conserving Surgery

et al. 2020

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The 2014 publication of the Society of Surgical Oncology-American Society for Radiation Oncology (SSO-ASTRO) Consensus Guideline on Margins for Breast-Conserving Surgery recommended a negative margin definition of no ink on tumor. Adoption of this guideline would represent a major change in surgical practice that could lower the rates of reoperation.OBJECTIVE To assess changes in reoperation rates after publication of the SSO-ASTRO guideline.DATA SOURCES A systematic search of Embase, PREMEDLINE, Evidence-Based Medicine Reviews, Scopus, and Web of Science for biomedical literature published from January 2014 to July 2019 was performed. This search was supplemented by web searches and manual searching of conference abstracts.STUDY SELECTION Included studies compared the reoperation rates in preguideline vs postguideline cohorts (actual change), retrospectively applied the SSO-ASTRO guideline to a preguideline cohort (projected change), or described the economic outcomes of the guideline.DATA EXTRACTION AND SYNTHESIS Study characteristics and reoperation rates were extracted independently by 2 reviewers. Odds ratios (ORs) were pooled by random effects meta-analysis. Analyses were stratified by study setting (institutional or population) and preguideline accepted margins. The economic outcomes of the guideline were summarized narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. MAIN OUTCOMES AND MEASURESOdds ratios for postguideline vs preguideline reoperation rates.RESULTS From 1114 citations, 30 studies (with 599 016 participants) reported changes in reoperation rates. Studies included a median (range) of 487 (100-521 578) participants, and 20 studies were undertaken in the US, 6 in the UK, 3 in Canada, and 1 in Australia. Among 21 studies of actual changes, pooled ORs showed a statistically significant reduction in reoperation, with an OR lower in institution-based studies than in population-based studies (OR, 0.62 [95% CI, 0.52-0.74] vs 0.76 [95% CI, 0.72-0.80]; P = .04 for subgroup differences). Among 9 studies of projected changes, the pooled OR was lower for preguideline margin thresholds of 2 mm or more compared with 1 mm (OR, 0.47 [95% CI, 0.40-0.56] vs 0.85 [95% CI, 0.79-0.91; P < .001 for subgroup differences). Projected changes were likely to overestimate actual changes. Six studies that estimated the postguideline economic outcome found the guideline to be potentially cost saving, with a median (range) saving of US $3540 ($1800-$25 650) per woman avoiding reoperation.CONCLUSIONS AND RELEVANCE This study found a decrease in reoperation rates after the publication of the SSO-ASTRO guideline; this reduction was greater at an institutional level than a population level, the latter reflecting the differences in guideline adoption between centers. These early outcomes may be conservative estimates of longer-term implications.

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Section: Resultsmentioning

confidence: 99%

Changes in Reoperation After Publication of Consensus Guidelines on Margins for Breast-Conserving Surgery

et al. 2020

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“…Despite the higher initial and recurrent costs of Savi Scout ® compared to WGL, it is likely that the lower re-excision rate, reduced device deployment time, shorter operating delays and greater scheduling flexibility will translate to greater cost-effectiveness and indirect financial savings (3,11). Facility providers can potentially save $4,721 per reexcision case avoided within the US healthcare setting (39). Moreover, switching from WGL to Savi Scout ® was estimated to result in cost savings of $1,972 per case due to reduction in operating room waiting time (20).…”

Section: Discussionmentioning

confidence: 99%

Savi Scout® Radar Localisation of Non-palpable Breast Lesions: Systematic Review and Pooled Analysis of 842 Cases

Kasem

Mokbel

2020

Anticancer Res

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Background/Aim: With the increase in detection of non-palpable breast lesions through screening, wire-guided localisation (WGL) has long been the favoured method for preoperative localisation. However, this technique comes with several limitations. New methods have been developed, including several non-radioactive, wireless options. We aimed to assess the effectiveness of Savi Scout ® localisation (SSL) through this pooled analysis and systematic review. Materials and Methods: A number of databases were searched for records reporting data on localisation and retrieval of SSL reflectors, as well as reexcision rate. We included our own data from 20 patients (22 reflectors) at our institution. Results: A total of 842 reflectors were inserted across eleven studies and our own data. Pooled analysis revealed an overall successful deployment rate of 99.64% and a successful retrieval rate of 99.64% using SSL. A statistically significant difference in re-excision rate was found in a smaller pooled analysis conducted across four studies comparing SSL and WGL (12.9% and 21.1% respectively, p<0.01). Conclusion: The Savi Scout ® localisation system is a safe and effective alternative to WGL. It facilitates flexible scheduling by decoupling radiology and surgery interventions and may reduce the need for re-excision procedures for positive surgical margins.

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“…The percentage of patients that are post-operatively identified to have positive surgical margins requiring repeated surgeries falls in a wide range, between 17.7 – 72% (Brown, et al, 2013; Huston, et al, 2006; Jacobs, 2008; Mendez, et al, 2006). The cost of re-excision surgeries are high, with the total annual cost for repeated lumpectomy procedures reported by one hospital to be $273,800, or $4721 per patient (Arora, 2015). Further, reimbursement rates for re-excision surgeries are low and are not always fully covered by insurance companies, with the same hospital reporting institutional losses from Medicare reimbursements of $540 per re-excision surgery (Arora, 2015).…”

Section: Outlook and Future Directions For Optical Chemical Probesmentioning

confidence: 99%

“…The cost of re-excision surgeries are high, with the total annual cost for repeated lumpectomy procedures reported by one hospital to be $273,800, or $4721 per patient (Arora, 2015). Further, reimbursement rates for re-excision surgeries are low and are not always fully covered by insurance companies, with the same hospital reporting institutional losses from Medicare reimbursements of $540 per re-excision surgery (Arora, 2015). Re-excision surgery represents a high cost burden on the healthcare system and highlights the potential for optical contrast agents to decrease overall healthcare costs while simultaneously improving patient outcomes.…”

Section: Outlook and Future Directions For Optical Chemical Probesmentioning

confidence: 99%

A Bright Future for Precision Medicine: Advances in Fluorescent Chemical Probe Design and Their Clinical Application

Garland

Yim

Bogyo

2016

Cell Chemical Biology

217

188

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The Precision Medicine Initiative aims to use advances in basic and clinical research to develop therapeutics that selectively target and kill cancer cells. Under the same doctrine of precision medicine, there is an equally important need to visualize these diseased cells to enable diagnosis, facilitate surgical resection and monitor therapeutic response. Therefore, there is a great opportunity for chemists to develop chemically tractable probes that can image cancer in vivo. This review focuses on recent advances in the development of optical probes as well as their current and future applications in the clinical management of cancer. The progress in probe development described here suggests that optical imaging is an important and rapidly developing field of study that encourages continued collaboration between chemists, biologists and clinicians to further refine these tools for interventional surgical imaging, as well as for diagnostic and therapeutic applications.

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Cost analysis of re-excisions for breast conserving surgery in Central Texas.

Cited by 9 publications

References 0 publications

Changes in Reoperation After Publication of Consensus Guidelines on Margins for Breast-Conserving Surgery

Changes in Reoperation After Publication of Consensus Guidelines on Margins for Breast-Conserving Surgery

Savi Scout® Radar Localisation of Non-palpable Breast Lesions: Systematic Review and Pooled Analysis of 842 Cases

A Bright Future for Precision Medicine: Advances in Fluorescent Chemical Probe Design and Their Clinical Application

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