Patient-level costs in margin re-excision for breast-conserving surgery

Abstract

Background: High rates of reoperation following breast-conserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported re-excision costs and compare the direct patient-level costs between patients undergoing successful BCS versus reoperations after BCS. Methods: The study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the Patient-Level Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = £0⋅75, £1 = €1⋅14 and US $1 = €0⋅85. Results: The median QHES score was 47 (i.q.r. 32⋅5-79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US $1234-11786 and $655-9136 respectively. Over a 12-month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was £4511 (range 1752-18 019), representing an additional £2136 per patient compared with BCS without reoperation (P < 0⋅001). Conclusion: The systematic review demonstrated variation in methodological approach to cost estimates and a paucity of high-quality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.

Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials

“…Moreover, patient reported outcomes of WGL include discomfort and pain [ 7 , 8 ]. As previously outlined, WGL is associated with margin positivity rates of up to 17%, which require reoperation (to ensure disease clearance), and additional cost [ 9 ]. Finally, the wire acts simply as a guide for the operating surgeon.…”

The Impact of Temporal Variation in Indocyanine Green Administration on Tumor Identification During Fluorescence Guided Breast Surgery

“…4 Positive margins are a major challenge during BCS, as reoperation has negative sequelae to both the patient and healthcare system, resulting in poorer cosmetic outcome, increased psychological burden, delays to neoadjuvant treatment, and increasing treatment costs by approximately $2360 per patient in the US 5 and £2136 per patient the UK. 6 In an attempt to decrease re-excision rates, a spectrum of technologies for intraoperative guidance has emerged. 7 However, limitations include inability to immediately visualize disease at the resection margin, counterintuitive feedback routines, an over-reliance on surgeon interpretation, and/or failure to integrate into the surgical workflow.…”

“… 4 Positive margins are a major challenge during BCS, as reoperation has negative sequelae to both the patient and healthcare system, resulting in poorer cosmetic outcome, increased psychological burden, delays to neoadjuvant treatment, and increasing treatment costs by approximately $2360 per patient in the US 5 and £2136 per patient the UK. 6 …”

Utilization of Raman spectroscopy to identify breast cancer from the water content in surgical samples containing blue dye

“…If there is residual tumour at the resected edge (positive margins) of the excised specimen, further resection is advised to reduce recurrence risk [1, 2]. This occurs in 17% of BCS in the UK [3], causing significant financial burden for the health service and patient anxiety [4]. There are currently no universally accepted methods of performing intra‐operative margin analysis (IMA) in BCS.…”