Flinders Medical Centre, Adelaide, SA.
Flinders University, Adelaide, SA.
Med J Aust. 2022 Feb 21;216(3):147-152. doi: 10.5694/mja2.51343. Epub 2021 Nov 16.
To assess the cost-effectiveness of breast reduction surgery for women with symptomatic breast hypertrophy in Australia.
Cost-utility analysis of data from a prospective cohort study.
SETTING, PARTICIPANTS: Adult women with symptomatic breast hypertrophy assessed for bilateral breast reduction at the Flinders Medical Centre, a public tertiary hospital in Adelaide, April 2007 - February 2018. The control group included women with breast hypertrophy who had not undergone surgery.
Health care costs (for the surgical admission and other related hospital costs within 12 months of surgery) and SF-6D utility scores (measure of health-related quality of life) were used to calculate incremental costs per quality-adjusted life-year (QALY) gained over 12 months, extrapolated to a 10-year time horizon.
Of 251 women who underwent breast reduction, 209 completed the baseline and at least one post-operation assessment (83%; intervention group); 124 of 350 invited women waiting for breast reduction surgery completed the baseline and 12-month assessments (35%; control group). In the intervention group, the mean SF-6D utility score increased from 0.313 (SD, 0.263) at baseline to 0.626 (SD, 0.277) at 12 months; in the control group, it declined from 0.296 (SD, 0.267) to 0.270 (SD, 0.257). The mean QALY gain was consequently greater for the intervention group (adjusted difference, 1.519; 95% CI, 1.362-1.675). The mean hospital cost per patient was $11 857 (SD, $4322), and the incremental cost-effectiveness ratio (ICER) for the intervention was $7808 per QALY gained. The probability of breast reduction surgery being cost-effective was 100% at a willingness-to-pay threshold of $50 000 per QALY and 88% at $28 033 per QALY.
Breast reduction surgery for women with symptomatic breast hypertrophy is cost-effective and should be available to women through the Australian public healthcare system.
评估澳大利亚有症状的乳房肥大女性行乳房缩小手术的成本效益。
前瞻性队列研究数据的成本效用分析。
地点、参与者：2007 年 4 月至 2018 年 2 月在阿德莱德的弗林德斯医疗中心接受双侧乳房缩小术评估的有症状乳房肥大的成年女性，该中心是一家公立的三级医院。对照组包括未行手术的乳房肥大女性。
手术入院和手术 12 个月内其他相关住院费用的医疗保健费用，以及 SF-6D 效用评分（健康相关生活质量的衡量标准），用于计算 12 个月内每获得一个质量调整生命年（QALY）的增量成本，并外推至 10 年时间范围。
251 名接受乳房缩小术的女性中，209 名完成了基线和至少一次术后评估（83%；干预组）；124 名受邀接受乳房缩小手术的 350 名女性中的 124 名完成了基线和 12 个月的评估（35%；对照组）。在干预组中，SF-6D 效用评分从基线时的 0.313（SD，0.263）增加到 12 个月时的 0.626（SD，0.277）；在对照组中，该评分从 0.296（SD，0.267）下降至 0.270（SD，0.257）。因此，干预组的平均 QALY 获益更高（调整差异，1.519；95%CI，1.362-1.675）。每位患者的平均医院费用为 11857 美元（SD，4322 美元），干预的增量成本效益比（ICER）为每获得一个 QALY 获益 7808 美元。在愿意支付的阈值为每 QALY 50000 美元时，乳房缩小术的成本效益为 100%，在每 QALY 28033 美元时为 88%。
对于有症状的乳房肥大女性，乳房缩小术具有成本效益，应通过澳大利亚公共医疗保健系统提供给女性。
