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Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction

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AMERICAN JOURNAL OF SURGERY 2000年第6期179卷 441-445页

作者： Palit, TK Miltenburg, DM Brunicardi, FC Baylor Coll Med Michael E DeBakey Dept Surg Houston TX 77030 USA

BACKGROUND: Breast conservation surgery (BCS), consisting of lumpectomy, axillary lymph node dissection, and radiation therapy, is as effective as modified radical mastectomy (MRM) for the treatment of early stage breast cancer. The costs of these treatment options have not been adequately addressed in the current era of increasing utilization of BCS and breast reconstruction. The purpose of this study is to determine differences in treatment costs among BCS, MRM alone, and MRM with reconstruction. METHODS: Patients with stage I and II breast cancer receiving inpatient treatment at a private university-affiliated hospital between January 1996 and July 1997 were analyzed (n = 230). Charges were determined as follows: inpatient and radiotherapy charges from the hospital billing department, surgeon fees from group practice billing codes, and radiotherapy physician fees from the radiation oncology group practice. Inpatient length of stay was obtained from hospital medical records. RESULTS: Average hospital inpatient charge for BCS was $4,748 (n = 74), $6,280 for MRM alone (P < 0.001, n = 132), and $11,946 for MRM with reconstruction (P < 0.001, n = 24). Surgeons' fees for BCS were $2,840, $3,500 for MRM alone, and $10,774 for MRM with reconstruction. The average radiotherapy charge was $18,742. Average length of stay was 1.03 days for BCS, 2.44 days for MRM alone (P < 0.001), and 3.71 days for MRM with reconstruction (P < 0.001). Average total cost of BCS ($26,330) was significantly greater than the average total cost of either MRM alone ($9,780, P < 0.001) or MRM with reconstruction ($22,720, P < 0.001). CONCLUSIONS: BCS is more expensive than MRM with or without reconstruction. It is the addition of radiotherapy that results in the higher total cost of CS. (C) 2000 by Excerpta Medica.

关键词：乳腺肿瘤/病理学乳腺肿瘤/外科学综合疗法成本及成本分析评价研究费用医疗/统计学和数值数据卫生保健费用医院收费/统计学和数值数据医院大学/经济学乳房切除术根治性/经济学乳房切除术根治性/方法乳房切除术区段/经济学乳房切除术区段/方法肿瘤分期概率修复外科手术/经济学修复外科手术/方法登记敏感性与特异性得克萨斯成年人老年人老年人 80以上女(雌)性人类中年人

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Shouldn't cost be considered a significant issue in medical care?

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AMERICAN JOURNAL OF SURGERY 2002年第1期183卷 4-6页

作者： Holden, JL Tower Surg Associates Med Grp Inc Ventura Cty Med Ctr Ventura CA 93003 USA

During the past 6 months, three major American surgical journals have published papers addressing the choices women make regarding treatment for breast cancer. The basic questions these papers posed were, Why don't more women choose breast conservation therapy'” and Why don't more of those who choose mastectomy choose to have reconstruction?” The authors drew the following conclusions: A surgeon?s input is important in a woman's choice to undergo BCS (breast conservation surgery) or MRM-R (modified radical mastectomy with reconstruction). However, it appears that if a woman wants to have MRM-NR (modified radical mastectomy without reconstruction), even when she is a candidate for BCS, the surgeon's input is overshadowed by the patient's fear of cancer” [Italics added for clarification.] [1]. Breast reconstruction is an underused option in breast cancer management. Predictors of the use of reconstruction do not reflect contraindications to the procedure, and indicate the need for both physician and patient education” [2]. These results suggest that better-educated and better-informed older women are more likely to undergo lumpectomy, and that physicians may influence breast cancer patients' decisions about surgery type” [3].

关键词：乳腺肿瘤/经济学乳腺肿瘤/放射疗法乳腺肿瘤/外科学决策循证医学卫生保健费用医院费用乳房切除术/经济学乳房切除术区段/经济学放射疗法辅助修复外科手术/经济学前哨淋巴结活组织检查/经济学女(雌)性人类

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Office based wire-guided open breast biopsy under local anesthesia is accurate and cost effective

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AMERICAN JOURNAL OF SURGERY 2000年第5期179卷 422-425页

作者： Morris, KT Pommier, RF Vetto, JT Oregon Hlth Sci Univ Dept Surg Sect Surg Oncol Portland OR 97201 USA

BACKGROUND: Mammographic abnormalities found to be malignant by stereotactic biopsy still require a wire-guided biopsy (WGB) in most cases. We have previously described a simplified method of WGB that allows the procedure to be done with a minimum of dissection and under local anesthesia in the office setting. We hypothesized that this procedure can be used to produce cost-effective, office-based breast preservation therapy (BPT). METHODS: We reviewed our recent experience with this WGB method to determine applicability and accuracy in the office setting. A cost-effectiveness analysis was also performed to determine potential charge reductions when this method is used to avoid operating room (OR) usage for either lumpectomy or lumpectomy plus sentinel lymph node biopsy (SLNB). RESULTS: Of the 164 biopsies reviewed, 114 (70%) were performed in the office setting under local anesthesia and 50 (30%) were performed in the OR. The most common reasons for choosing the OR setting included performance of biopsy during an unrelated procedure requiring the OR (16 cases), patient preference (12), deep lesions (6), and the inability of the patient to cooperate with local anesthesia (5). The complication rates were similar between the two settings (7% for office-based and 4% for OR;P = 0.697), and in neither setting were any lesions missed. A cost-effectiveness analysis using our Current Procedure Terminology (CPT)-based charges revealed a potential per-case charge reduction of $4,632 for office-based lumpectomy and $4306 for office-based lumpectomy/SLNB, using our method of WGB and local anesthesia, compared with the OR setting. CONCLUSIONS: Office-based WGB using our previously described method is accurate and can be applied to at least 70% of patients. Based on the favorable results of our cost analysis and rising support for SLNB, we anticipate increased utilization of the clinic setting and local anesthesia for BPT in the future, (C) 2000 by Excerpta Medica, Inc.

关键词：算法麻醉局部/经济学麻醉局部/方法活组织检查/经济学活组织检查/方法乳腺肿瘤/病理学乳腺肿瘤/放射摄影术费用效益分析可行性研究乳房X线摄影术/经济学乳房X线摄影术/方法乳房切除术区段/经济学乳房切除术区段/方法诊室就医/经济学手术室/经济学病人遴选放射摄影术介入性/经济学放射摄影术介入性/方法可重复性结果治疗结果成年人老年人老年人 80以上女(雌)性人类中年人

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