Skip to main content

Advertisement

SpringerLink
Log in

Cost-Effectiveness of Contralateral Prophylactic Mastectomy for Prevention of Contralateral Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A growing number of women with sporadic unilateral, early-stage breast cancers are undergoing ipsilateral therapeutic mastectomy with contralateral prophylactic mastectomy (CPM) to prevent the development of new cancers in the contralateral breast.

Methods

A decision-tree using TreeAge Pro 2012 software was used to model the costs and effects of CPM versus unilateral mastectomy (UM) in women younger than 50 years of age with sporadic unilateral, early stage breast cancers. Cost estimates were obtained from the Medicare Fee Schedule and the Healthcare Utilization Project. Probability estimates were obtained from the literature. Outcome effects were measured by incremental cost per quality-adjusted life year (QALY) gained. A 10-year risk period for contralateral breast cancer (CBC), a lifetime time horizon, and a societal perspective were used.

Results

Treatment with CPM results in 0.2 QALYs less than UM and $279 less in costs during a 10-year risk period and lifetime follow-up. The resulting incremental cost effectiveness ratio (ICER) is a savings of $1397 per QALY lost. The ICER is sensitive to the rate and method of postmastectomy reconstruction and the cost of radiologic surveillance after UM.

Conclusions

CPM is cost-saving for the prevention of CBC in women younger than 50 years of age with sporadic, unilateral, early-stage breast cancers, but also reduces resulting health. The savings for health lost are insufficient to be considered cost-effective at this time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Breast Cancer Home Page—National Cancer Institute. http://www.cancer.gov/cancertopics/types/breast. Accessed 13 Feb 2011.

  2. Fast Stats. http://seer.cancer.gov/faststats. Accessed 12 Aug 2013.

  3. Townsend CM, Sabiston DC. Sabiston textbook of surgery: the biological basis of modern surgical practice. 17th ed. Philadelphia: Saunders; 2004.

    Google Scholar 

  4. Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–9.

    Article  PubMed  Google Scholar 

  5. Brewster AM, Parker PA. Current knowledge on contralateral prophylactic mastectomy among women with sporadic breast cancer. Oncologist. 2011;16(7):935–41.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Cemal Y, Albornoz CR, Disa JJ, et al. A paradigm shift in U.S. breast reconstruction: part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg. 2013;131(3):320e–6e.

    Article  CAS  PubMed  Google Scholar 

  7. Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010;11:CD002748.

    PubMed  Google Scholar 

  8. BougheyJC, HoskinTL, DegnimAC et al.Contralateral prophylactic mastectomy is associated with a survival advantage in high-risk women with a personal history of breast cancer. Ann Surg Oncol. 2010;17:2702–9.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Bedrosian I, Hu CY, Chang GJ. Population-based study of contralateral prophylactic mastectomy and survival outcomes of breast cancer patients. J Natl Cancer Inst. 2010;102:401–9.

    Article  PubMed  Google Scholar 

  10. Drummond MF, Sculpher MJ, Torrance GW, Obrien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes, 3rd ed. New York: Oxford University Press, 2005.

    Google Scholar 

  11. Medicare Fee Schedule | Payment | TrailBlazerHealth.com. http://www.trailblazerhealth.com/Tools/FeeSchedule/MedicareFeeSchedule.aspx. Accessed 4 May 2011.

  12. HCUPnet: A tool for identifying, tracking, and analyzing national hospital statistics. http://hcupnet.ahrq.gov. Accessed 4 May 2011.

  13. Barton MB, West CN, Liu IL, et al. Complications following bilateral prophylactic mastectomy. J Natl Cancer Inst Monogr. 2005;35:61–6.

    Article  PubMed  Google Scholar 

  14. Frost MH, Slezak JM, Tran NV, et al. Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance. J Clin Oncol. 2005;23(31):7849–56.

    Article  PubMed  Google Scholar 

  15. Goldflam K, Hunt KK, Gershenwald JE, et al. Contralateral prophylactic mastectomy. Predictors of significant histologic findings. Cancer. 2004;101(9):1977–86.

    Article  PubMed  Google Scholar 

  16. Brenner H, Hakulinen T. Are patients diagnosed with breast cancer before age 50 years ever cured? J Clin Oncol. 2004;22(3):432–8.

    Article  PubMed  Google Scholar 

  17. Age National Health Expenditure Data. https://www.cms.gov/NationalHealthExpendData/04_NationalHealthAccountsAgePHC.asp#TopOfPage. Accessed 4 May 2011.

  18. Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24(31):5091–7.

    Article  PubMed  Google Scholar 

  19. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Breast Cancer Version 1.2014. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 27 Dec 2013.

  20. de la Rochefordière A, Mouret-Fourme E, Asselain B, et al. Metachronous contralateral breast cancer as first event of relapse. Int J Radiat Oncol Biol Phys. 1996;36(3):615–21.

    Article  PubMed  Google Scholar 

  21. Robinson A, Speers C, Olivotto I, Chia S. Method of detection of new contralateral primary breast cancer in younger versus older women. Breast Cancer. 2007;7(9):705–9.

    Article  PubMed  Google Scholar 

  22. Zendejas B, Moriarty JP, O’Byrne J, Degnim AC, Farley DR, Boughey JC. Cost-effectiveness of contralateral prophylactic mastectomy versus routine surveillance in patients with unilateral breast cancer. J Clin Oncol. 2011;29(22):2993–3000.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Burstein HJ, Prestrud AA, Seidenfeld J, et al. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol. 2010;28(23):3784–96.

    Article  PubMed  Google Scholar 

  24. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005;353(16):1659–72.

    Article  CAS  PubMed  Google Scholar 

  25. Centers for Disease Control and Prevention: body measurements. http://www.cdc.gov/nchs/fastats/bodymeas.htm. Accessed 27 Dec 2013.

  26. McDonnell SK, Schaid DJ, Myers JL, et al. Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. J Clin Oncol. 2001;19(19):3938–43.

    CAS  PubMed  Google Scholar 

  27. Zion SM, Slezak JM, Sellers TA, et al. Reoperations after prophylactic mastectomy with or without implant reconstruction. Cancer. 2003;98(10):2152–60.

    Article  PubMed  Google Scholar 

  28. Polednak AP. Geographic variation in postmastectomy breast reconstruction rates. Plast Reconstr Surg. 2000;106(2):298–301.

    Article  CAS  PubMed  Google Scholar 

  29. Platt J, Baxter N, Zhong. Breast reconstruction after mastectomy for breast cancer. CMAJ. 2011;183(18):2109–16.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16(10):2697–704.

    Article  PubMed  Google Scholar 

  31. Whitehead SJ, Ali S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010;96:5–21.

    Article  PubMed  Google Scholar 

  32. A review and meta-analysis of health state utility values in breast cancer—White Rose Research Online. http://eprints.whiterose.ac.uk/11227/. Accessed 4 May 2011.

  33. Meunnig P. Cost-effectiveness analysis in health: a practical approach, 2nd ed. San Francisco: Jossey-Bass, 2008.

    Google Scholar 

  34. Noah-Vanhoucke J, Green LE, Dinh TA, Alperin P, Smith RA. Cost-effectiveness of chemoprevention of breast cancer using tamoxifen in a postmenopausal US population. Cancer. 2011;117(15):3322–31.

    Google Scholar 

  35. Alkner S, Bendahl PO, Ferno M, Nordenskjold B, Ryden L, South Swedish and South-East Swedish Breast Cancer Groups. Tamoxifen reduces the risk of contralateral breast cancer in premenopausal women: results from a controlled randomised trial. Eur J Cancer. 2009;45(14):2496–502.

    Article  CAS  PubMed  Google Scholar 

  36. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90(18):1371–88.

    Article  CAS  PubMed  Google Scholar 

  37. Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ. Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg. 2000;180(6):439–45.

    Article  CAS  PubMed  Google Scholar 

  38. Overview of BLS Wage Data by Area and Occupation. http://www.bls.gov/bls/blswage.htm#National. Accessed 4 May 2011.

  39. Nattinger AB, Kneusel RT, Hoffmann RG, Gilligan MA. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst. 2001;93(17):1344–6.

    Article  CAS  PubMed  Google Scholar 

  40. Haynes R, Jones AP, Sauerzapf V, Zhao H. Validation of travel times to hospital estimated by GIS. Int J Health Geogr. 2006;5:40.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Official 2011 IRS Mileage Rate with 2010 IRS Mileage Reimbursement Info. http://www.panache-yes.com/mileagerate.html. Accessed 4 May 2011.

  42. Ghosh K, Melton LJ,3rd, Suman VJ, Grant CS, Sterioff S, Brandt KR, et al. Breast biopsy utilization: a population-based study. Arch Intern Med. 2005;165(14):1593–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Toronto, Toronto, ON, Canada

    Amanda Roberts MD, MPH

  2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Amanda Roberts MD, MPH & Kevin D. Frick PhD

  3. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Mehran Habibi MD

Authors
  1. Amanda Roberts MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehran Habibi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin D. Frick PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amanda Roberts MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roberts, A., Habibi, M. & Frick, K.D. Cost-Effectiveness of Contralateral Prophylactic Mastectomy for Prevention of Contralateral Breast Cancer. Ann Surg Oncol 21, 2209–2217 (2014). https://doi.org/10.1245/s10434-014-3588-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3588-7

Keywords

Search

Navigation