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Cost of Contralateral Prophylactic Mastectomy

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To compare the healthcare costs of women with unilateral breast cancer who underwent contralateral prophylactic mastectomy (CPM) with those of women who did not.

Methods

We conducted a retrospective study of 904 women treated for stage I–III breast cancer with or without CPM. Women were matched according to age, year at diagnosis, stage, and receipt of chemotherapy. We included healthcare costs starting from the date of surgery to 24 months. We identified whether care was immediate or delayed (CPM within 6 months or 6–24 months after initial surgery, respectively). Costs were converted to approximate Medicare reimbursement values and adjusted for inflation. Multivariable regression analysis was performed to evaluate the effect of CPM on total breast cancer care costs adjusting for patient characteristics and accounting for matched pairs.

Results

The mean difference between the CPM and no-CPM matched groups was $3,573 (standard error [SE] $455) for professional costs, $4,176 (SE $1,724) for technical costs, and $7,749 (SE $2,069) for total costs. For immediate and delayed CPM, the mean difference for total costs was $6,528 (SE $2,243) and $16,744 (SE $5,017), respectively. In multivariable analysis, the CPM group had a statistically significant increase of 16.9 % in mean total costs compared with the no-CPM group (p < 0.0001). Human epidermal growth factor receptor 2/neu-positive status, receipt of radiation, and reconstruction were associated with increases in total costs.

Conclusions

CPM significantly increases short-term healthcare costs for women with unilateral breast cancer. These patient-level cost results can be used for future studies that evaluate the influence of costs of CPM on decision making.

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Acknowledgment

The authors wish to thank Robert Prater for research data support, and Zach Bohannan and Dawn Chalaire for editorial contributions that enhanced the quality of the manuscript. Financial support for this study was provided by grant number 5 R21 CA149803 (AMB, PAP) from the National Cancer Institute, and National Institute of Health Cancer Center Support grant P30CA016672 for shared resources. The funding agreements ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report.

Disclosure

Ashish A. Deshmukh, Scott B. Cantor, Melissa A. Crosby, Wenli Dong, Yu Shen, Isabelle Bedrosian, Susan K. Peterson, Patricia A. Parker, and Abenaa M. Brewster declare no conflict of interest.

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Authors and Affiliations

  1. Department of Health Services Research – Unit 1444, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ashish A. Deshmukh MPH & Scott B. Cantor PhD

  2. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Melissa A. Crosby MD

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Wenli Dong MS & Yu Shen PhD

  4. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Isabelle Bedrosian MD

  5. Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Susan K. Peterson MPH, PhD & Patricia A. Parker PhD

  6. Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Abenaa M. Brewster MD, MHS

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  1. Ashish A. Deshmukh MPH
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  2. Scott B. Cantor PhD
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  3. Melissa A. Crosby MD
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  6. Isabelle Bedrosian MD
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  9. Abenaa M. Brewster MD, MHS
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Correspondence to Scott B. Cantor PhD.

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Deshmukh, A.A., Cantor, S.B., Crosby, M.A. et al. Cost of Contralateral Prophylactic Mastectomy. Ann Surg Oncol 21, 2823–2830 (2014). https://doi.org/10.1245/s10434-014-3759-6

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  • DOI: https://doi.org/10.1245/s10434-014-3759-6

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