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Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine

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Abstract

Purpose

Breast cancer is a complex disease with heterogeneous outcomes that may benefit from the implementation of Predictive, Preventive, and Personalized Medicine (PPPM/3PM) strategies. In this study, we aimed to explore the potential of PPPM approaches by investigating the 10-year trends in quality of life (QOL) and the cost-effectiveness of different types of surgeries for patients with breast cancer.

Methods

This prospective cohort study recruited 144 patients undergoing breast conserving surgery (BCS), 199 undergoing modified radical mastectomy (MRM), and 44 undergoing total mastectomy with transverse rectus abdominis myocutaneous flap (TRAMF) from three medical centers in Taiwan between June 2007 and June 2010.

Results

All patients exhibited a significant decrease in most QOL dimension scores from before surgery to 6 months postoperatively (p < 0.05); however, from postoperative year 1 to 2, improvement in most QOL dimension scores was significantly better in the TRAMF group than in the BCS and MRM groups (p < 0.05). At 2, 5, and 10 years after surgery, the patients’ QOL remained stable. In the Markov decision tree model, the TRAMF group had higher total direct medical costs than the MRM and BCS groups (US$ 32,426, US$ 29,487, and US$ 28,561, respectively) and higher average QALYs gained (7.771, 6.773, and 7.385, respectively), with an incremental cost–utility ratio (ICUR) of US$ 2,944.39 and US$ 10,013.86 per QALY gained.

Conclusions

TRAMF appeared cost effective compared with BCS and MRM, and it has been proved with considerable QOL improvements in the framework of PPPM. Future studies should continue to explore the potential of PPPM approaches in breast cancer care. By incorporating predictive models, personalized treatment plans, and preventive strategies into routine clinical practice, we can further optimize patient outcomes and reduce healthcare costs associated with breast cancer treatment.

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Data availability

The datasets used in the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

QOL:

Quality of life

BCS:

Breast-conserving surgery

MRM:

Modified radical mastectomy

TRAMF:

Transverse rectus abdominis myocutaneous flap

PF:

Physical functioning

RF:

Role functioning

EF:

Emotional functioning

CF:

Cognitive functioning

SF:

Social functioning

FA:

Fatigue

NV:

Nausea and vomiting

PA:

Pain

DY:

Dyspnea

SL:

Insomnia

AP:

Appetite loss

CO:

Constipation

DI:

Diarrhea

FI:

Financial difficulties

QL:

Quality of life

BRBI:

Body image

BRSEF:

Sexual functioning

BRSEE:

Sexual enjoyment

BRFU:

Future perspective

BRST:

Side effects

BRBS:

Breast symptoms

BRAS:

Arm symptoms

BRHL:

Hair loss and upset

CCI:

Charlson comorbidity index

ASA:

American Society of Anesthesiology

ICUR:

Incremental cost-utility ratio

GEE:

Generalized estimating equation

ES:

Effect size

IPTW:

Inverse probability of treatment weighting

QALYs:

Quality-adjusted life-years

AUROC:

Area under the receiver operating characteristic

WTP:

Willingness to pay

GDP:

Gross domestic product

NMB:

Net monetary benefit

CUAC:

Cost utility acceptability curve

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Funding

This study was supported by funding from “the Ministry of Science and Technology” in Taiwan (NSC99-2314-B-037–069-MY3, MOST 102–2314-B-037–043, MOST 110–2314-B-037–003, and MOST 110–2314-B-037–004).

Author information

Authors and Affiliations

  1. Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan

    Hon-Yi Shi, Chiu-Hui Li & Yen-Chen Chen

  2. Department of Business Management, National Sun Yat-Sen University, Kaohsiung, 80420, Taiwan

    Hon-Yi Shi

  3. Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan

    Hon-Yi Shi

  4. Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402, Taiwan

    Hon-Yi Shi

  5. Superintendent Office Secretary Admission Service Center, Health Management and Occupational Safety and Health Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 81267, Taiwan

    Chiu-Hui Li

  6. Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445, Taiwan

    Chong-Chi Chiu

  7. School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445, Taiwan

    Chong-Chi Chiu

  8. Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445, Taiwan

    Chong-Chi Chiu

  9. Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, 73658, Taiwan

    Hao-Hsien Lee

  10. Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, No. 100, Shih-Chuan 1St Road, Kaohsiung, 80708, Taiwan

    Ming-Feng Hou

  11. Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan

    Ming-Feng Hou

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Contributions

HYS and MFH contributed to conceptualization, data curation, formal analysis, supervision, investigation, writing-original draft, writing review, and editing. CHL, YCC, CCC, and HHL contributed to data curation, investigation, writing review, and editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ming-Feng Hou.

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Ethics approval

This study has been approved by the Institutional Review Board (MUH-IRB-960186).

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All study participants provided written informed consent to the study.

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Shi, HY., Li, CH., Chen, YC. et al. Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine. EPMA Journal 14, 457–475 (2023). https://doi.org/10.1007/s13167-023-00326-4

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  • DOI: https://doi.org/10.1007/s13167-023-00326-4

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