Ann Arbor, Mich.; and Baltimore, Md.
From the Section of Plastic Surgery, University of Michigan Health System; and the Department of Plastic Surgery, The Johns Hopkins Hospital.
Plast Reconstr Surg. 2018 May;141(5):1094-1102. doi: 10.1097/PRS.0000000000004272.
Contralateral prophylactic mastectomy may be unnecessary from an oncologic perspective; therefore, the debate persists about the value of contralateral prophylactic mastectomy in women with early-stage unilateral breast cancer. Given finite health care resources, this study aims to evaluate the cost of contralateral prophylactic mastectomy and breast reconstruction.
Women with unilateral breast cancer undergoing either unilateral mastectomy or unilateral mastectomy with contralateral prophylactic mastectomy and immediate breast reconstruction were selected from the Truven MarketScan databases between 2009 and 2013. Demographic and treatment data were recorded, and over an 18-month follow-up period, the treatment cost was tallied. A log-transformed linear model was used to compare cost between the groups.
A total of 2343 women were identified who met our inclusion criteria, with 1295 undergoing unilateral mastectomy and 1048 undergoing contralateral prophylactic mastectomy. Complication rates within 18 months were similar for women undergoing unilateral mastectomy and contralateral prophylactic mastectomy (39 percent versus 42 percent; p = 0.17). Management with unilateral mastectomy with reconstruction required an adjusted cumulative mean cost of $33,557. Contralateral prophylactic mastectomy with reconstruction was an additional $11,872 in expenditure (p < 0.001). The cost of initial procedures (mean difference, $6467) and secondary procedures (mean difference, $2455) were the greatest contributors to cost.
In women with unilateral breast cancer, contralateral prophylactic mastectomy with reconstruction is more costly. The increased monetary cost of contralateral prophylactic mastectomy may be offset by improved quality of life. However, this financial reality is an important consideration when ongoing efforts toward reimbursement reform may not pay for contralateral prophylactic mastectomy if outcomes data are not presented to justify this procedure.
从肿瘤学的角度来看，对侧预防性乳房切除术可能是不必要的；因此，对于早期单侧乳腺癌患者，对侧预防性乳房切除术的价值仍然存在争议。鉴于有限的医疗保健资源，本研究旨在评估对侧预防性乳房切除术和乳房重建的成本。
从 2009 年至 2013 年的 Truven MarketScan 数据库中选择单侧乳房切除术或单侧乳房切除术加对侧预防性乳房切除术和即刻乳房重建的单侧乳腺癌女性。记录人口统计学和治疗数据，并在 18 个月的随访期间，汇总治疗费用。使用对数线性模型比较两组之间的成本。
共确定了 2343 名符合纳入标准的女性，其中 1295 名接受了单侧乳房切除术，1048 名接受了对侧预防性乳房切除术。18 个月内，单侧乳房切除术和对侧预防性乳房切除术的并发症发生率相似（39%比 42%；p=0.17）。接受单侧乳房切除术加重建的患者的调整后累积平均费用为 33557 美元。对侧预防性乳房切除术加重建需要额外支出 11872 美元（p<0.001）。初始手术（平均差异，6467 美元）和二次手术（平均差异，2455 美元）的费用是导致成本增加的最大因素。
在单侧乳腺癌患者中，对侧预防性乳房切除术加重建的成本更高。对侧预防性乳房切除术增加的货币成本可能会因生活质量的提高而得到弥补。然而，在持续努力进行报销改革的情况下，如果没有提供数据来证明这种手术的合理性，那么财务现实是一个重要的考虑因素。
