Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation

Yang, Rachel; Newman, Andrew S.; Lin, Ines C.; Reinke, Caroline E.; Karakousis, Giorgos C.; Czerniecki, Brian J.; Wu, Liza C.; Kelz, Rachel R.

doi:10.1002/cncr.28050

Cited by 105 publications

(86 citation statements)

References 29 publications

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“…In contrast to the literature, 4,10 our study found that physician services followed by outpatient services were the major contributors to the average total costs indicating an increased breast-conserving therapies 30,31 and new adjuvant therapies that require more frequent monitoring as reflected by higher adjusted costs associated with surgery and/or adjuvant therapy in Table 3. These findings likely represent several changes in treatment patterns, including increased costs of multimodal treatments 29–33 and use of more expensive radiation technology, such as brachytherapy and intensity-modulated RT, 29 which may have increased costs associated with physician and outpatient services.…”

Section: Discussioncontrasting

confidence: 87%

Healthcare Utilization and Costs During the Initial Phase of Care Among Elderly Women With Breast Cancer

Vyas¹,

Madhavan²,

Sambamoorthi³

et al. 2017

J Natl Compr Canc Netw

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Background Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service beneficiaries diagnosed with BC, and to determine the factors associated with higher costs. Methods A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003–2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. Results A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66–69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. Conclusions The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.

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Section: Discussioncontrasting

confidence: 87%

Healthcare Utilization and Costs During the Initial Phase of Care Among Elderly Women With Breast Cancer

Vyas¹,

Madhavan²,

Sambamoorthi³

et al. 2017

J Natl Compr Canc Netw

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“…Perhaps, the most important was implementation of the Women’s Health & Cancer Rights Act in 1998, in which payers were required to provide benefits for mastectomy-related services including, but not limited to, all stages of reconstruction and surgeries aimed to restore symmetry between the breasts. Recent information on disparities in reconstruction rates across the nation highlighted the fact that many women were unaware about breast reconstruction or insurance benefit coverage [37, 38]. As a result, individual states, such as NY, now have legislation which mandates information be given to women about breast reconstruction, or have a consultation with a plastic surgeon after diagnosis with breast cancer [14, 37].…”

Section: The Rate Of Breast Reconstructionmentioning

confidence: 99%

Current Trends in Postmastectomy Breast Reconstruction

Panchal¹,

Matros²

2017

Plastic &Amp; Reconstructive Surgery

307

229

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SUMMARY Post-mastectomy immediate breast reconstruction in the US continues to experience an upward trend owing to heightened awareness, innovations in reconstructive technique, growing evidence of improved patient reported outcomes and shifts in mastectomy patterns. Women with unilateral breast cancer are increasingly electing to undergo contralateral prophylactic mastectomy, instead of unilateral mastectomy or opting for breast conservation. The ascent in prophylactic surgeries correlates temporally to a shift towards prosthetic methods of reconstruction as the most common technique. Factors associated with the choice for implants include younger age, quicker recovery time, along with documented safety and enhanced aesthetic outcomes with newer generations of devices. Despite advances in autologous transfer, its growth is constrained by the greater technical expertise required to complete microsurgical transfer and potential barriers such as poor relative reimbursement. The increased use of radiation as an adjuvant treatment for management of breast cancer has created additional challenges for plastic surgeons who need to consider the optimal timing and method of breast reconstruction to perform in these patients.

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“…Drivers of this trend are multifactorial; in addition to the Women’s Health and Cancer Rights Act, patients benefit from advances in reconstructive techniques, expanded availability of plastic surgeons, and growing comfort of breast surgeons in pursuing immediate reconstruction at the time of the initial cancer surgery. 10–14 However, although overall rates of reconstruction have increased, substantial variation exists regarding who undergoes reconstruction. 10–24 Breast reconstruction following mastectomy is an elective component of breast cancer treatment and reconstruction is not the right choice for everyone.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors

et al. 2017

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Background Post-mastectomy reconstruction is a critical component of high-quality breast cancer care. Prior studies demonstrate socioeconomic disparity in receipt of reconstruction. Our objective was to evaluate trends in receipt of immediate reconstruction and examine socio-economic factors associated with reconstruction in a contemporary cohort. Methods Using the National Cancer Database, we identified women < 75 years of age with stage 0-1 breast cancer treated with mastectomy (n=297,121). Trends in immediate reconstruction rates (2004-2013) for the overall cohort and stratified by socioeconomic factors were examined using Join-point regression analysis. Annual percent change (APC) was calculated. We then restricted our sample to a contemporary cohort (2010-2013, n=145,577). Multivariable logistic regression identified socioeconomic factors associated with immediate reconstruction. Average adjusted predicted probabilities of receiving reconstruction were calculated. Results Immediate reconstruction rates increased from 27% to 48%. Although absolute rates of reconstruction for each stratification group increased, similar APC’s across strata led to persistent gaps in receipt of reconstruction. On multivariable logistic regression using our contemporary cohort, race, income, education, and insurance type were all strongly associated with immediate reconstruction. Patients with the lowest predicted probability of receiving reconstruction were patients with Medicaid who live in areas with the lowest rates of high school graduation (black 42.4 (40.5-44.3)%, white 45.7 (43.9-47.4)%). Conclusions Although reconstruction rates have increased dramatically over the past decade, lower rates persist for disadvantaged patients. Understanding how socioeconomic factors influence receipt of reconstruction and identifying modifiable factors are critical next steps towards identifying interventions to reduce disparities in breast cancer surgical care.

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Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation

Cited by 105 publications

References 29 publications

Healthcare Utilization and Costs During the Initial Phase of Care Among Elderly Women With Breast Cancer

Healthcare Utilization and Costs During the Initial Phase of Care Among Elderly Women With Breast Cancer

Current Trends in Postmastectomy Breast Reconstruction

Socioeconomic Factors Associated with Post-Mastectomy Immediate Reconstruction in a Contemporary Cohort of Breast Cancer Survivors

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