Different treatments for early-stage breast cancer vary in their cost-effectiveness, according to a study published online April 10 in the Journal of the National Cancer Institute.
In recent years, more women have been choosing bilateral mastectomy and reconstruction to treat early breast cancer -- often driven by nonmedical factors such as a preference for removing the entire organ due to anxiety about cancer recurrence, researchers from MD Anderson Cancer Center wrote. However, other options such as lumpectomy, lumpectomy plus whole-breast irradiation, or lumpectomy plus brachytherapy may be just as effective, with fewer complications and lower cost.
A team led by Dr. Benjamin Smith included data from 105,211 women with early breast cancer who were diagnosed between 2000 and 2011. The researchers identified treatment complications within 24 months of diagnosis, compared complications by treatment, and calculated mean total and complication-related cost from an insurance perspective (J Natl Cancer Inst, April 2017, Vol. 109:1, pp. 1-9).
The most common treatment was lumpectomy plus whole-breast irradiation, according to the group. Mastectomy plus reconstruction had nearly twice the complication risk of lumpectomy plus whole-breast irradiation (54.3% versus 29.6% among younger women with private insurance and 66.1% versus 37.6% among older women with Medicare). It was also associated with a higher total cost (an average $22,481 more for the younger group versus an average $1,748 more for the older group) and a higher complication-related cost (an average $9,017 more for younger women and $2,092 more for older women).
Brachytherapy had somewhat higher total cost and complications than whole-breast irradiation treatment, the researchers found, while lumpectomy alone incurred lower costs and complications, but only in the Medicare cohort.
The fact that mastectomy with reconstruction resulted in high costs highlights an important conflict in an era of "value-based" medical care, according to a statement issued by the journal. Patients may prefer a more expensive treatment, such as mastectomy plus reconstruction treatment, for nonmedical reasons, even though a less expensive treatment may be considered just as effective medically.
