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Showing content from https://pubmed.ncbi.nlm.nih.gov/27678203/ below:

Cost and Complications of Local Therapies for Early-Stage Breast Cancer

. 2016 Sep 27;109(1):djw178. doi: 10.1093/jnci/djw178. Print 2017 Jan. Cost and Complications of Local Therapies for Early-Stage Breast Cancer Jing Jiang¹, Ya-ChenTina Shih¹, Sharon H Giordano¹, Jinhai Huo¹, Reshma Jagsi¹, Adeyiza O Momoh¹, Abigail S Caudle¹, Kelly K Hunt¹, Simona F Shaitelman¹, Thomas A Buchholz¹, Shervin M Shirvani¹

Affiliations

Affiliation

¹ Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).

PMID: 27678203
PMCID: PMC6075189
DOI: 10.1093/jnci/djw178

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Cost and Complications of Local Therapies for Early-Stage Breast Cancer

Benjamin D Smith et al. J Natl Cancer Inst. 2016.

. 2016 Sep 27;109(1):djw178. doi: 10.1093/jnci/djw178. Print 2017 Jan. Authors Benjamin D Smith¹, Jing Jiang¹, Ya-ChenTina Shih¹, Sharon H Giordano¹, Jinhai Huo¹, Reshma Jagsi¹, Adeyiza O Momoh¹, Abigail S Caudle¹, Kelly K Hunt¹, Simona F Shaitelman¹, Thomas A Buchholz¹, Shervin M Shirvani¹ Affiliation

¹ Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).

PMID: 27678203
PMCID: PMC6075189
DOI: 10.1093/jnci/djw178

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Erratum in

Corrigendum.
[No authors listed] [No authors listed] J Natl Cancer Inst. 2018 Oct 1;110(10):1148-1152. doi: 10.1093/jnci/djy135. J Natl Cancer Inst. 2018. PMID: 30016506 Free PMC article. No abstract available.

Abstract

Background: Guideline-concordant local therapy options for early breast cancer include lumpectomy plus whole breast irradiation (Lump+WBI), lumpectomy plus brachytherapy, mastectomy alone, mastectomy plus reconstruction, and, in older women, lumpectomy alone. We performed a comparative examination of each treatment's complications and cost to assess their relative values.

Methods: Using the MarketScan database of younger women with private insurance and the SEER-Medicare database of older women with public insurance, we identified 105 211 women with early breast cancer diagnosed between 2000 and 2011. We used diagnosis and procedural codes to identify treatment complications within 24 months of diagnosis and compared complications by treatment using two-sided logistic regression. Mean total and complication-related cost, relative to Lump+WBI, were calculated from a payer's perspective and adjusted for differences in covariables using linear regression. All statistical tests were two-sided.

Results: Lump+WBI was the most commonly used treatment. Mastectomy plus reconstruction was associated with nearly twice the complication risk of Lump+WBI (Marketscan: 54.3% vs 29.6%, relative risk [RR] = 1.87, 95% confidence interval [CI] = 1.82 to 1.91, P < .001; SEER-Medicare: 66.1% vs 37.6%, RR = 1.75, 95% CI = 1.69 to 1.82, P < .001) and was also associated with higher adjusted total cost (Marketscan: $22 481 greater than Lump+WBI; SEER-Medicare: $1748 greater) and complication-related cost (Marketscan: $9017 greater; SEER-Medicare: $2092 greater). Brachytherapy had modestly higher total cost and complications than WBI. Lumpectomy alone entailed lower cost and complications in the SEER-Medicare cohort only.

Conclusions: Mastectomy plus reconstruction results in substantially higher complications and cost than other guideline-concordant treatment options for early breast cancer. These findings are relevant to patients evaluating their local therapy options and to value-based population health management.

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Figures
Figure 1.

Complications by year of diagnosis…

Figure 1.

Complications by year of diagnosis and local therapy (unadjusted). Unadjusted time trends in…

Figure 1.

Complications by year of diagnosis and local therapy (unadjusted). Unadjusted time trends in risk of any complication by type of local therapy. Data for lumpectomy plus brachytherapy in 2000 and 2001 are not shown for the MarketScan cohort because of small numbers (n = 5). SEER = Surveillance, Epidemiology, and End Results; WBI = whole breast irradiation.

Figure 2.

Adjusted total and complication-related cost…

Figure 2.

Adjusted total and complication-related cost relative to lumpectomy and whole breast irradiation for…

Figure 2.

Adjusted total and complication-related cost relative to lumpectomy and whole breast irradiation for patients diagnosed in 2010 and 2011. Adjusted difference in total cost and complication-related cost of local therapy options, relative to lumpectomy plus whole breast irradiation, for patients diagnosed in 2010 and 2011. SEER = Surveillance, Epidemiology, and End Results; WBI = whole breast irradiation.