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Contralateral Prophylactic Mastectomy with Immediate Breast Reconstruction Increases Healthcare Utilization and Cost

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

Abstract

Background

The rates of contralateral prophylactic mastectomy (CPM) in women with unilateral breast cancer continue to rise, especially in women undergoing immediate breast reconstruction (IBR).

Methods

We utilized administrative claims data from a large US commercial insurance database (OptumLabs) to identify women age 18–64 years who underwent IBR between January 2004 and December 2013. We compared 2-year unadjusted utilization rates and total costs of care between unilateral mastectomy (UM) and bilateral mastectomy (BM) for implant-based and autologous reconstruction. Comparisons were tested using t-test and differences in cost were estimated using the Wilcoxon rank-sum test.

Results

Overall, 11,235 women undergoing mastectomy with IBR were identified; 7319 with implant reconstruction [1923 UM (26%) and 5396 BM (74%)] and 3916 with autologous reconstruction [1687 UM (43%) and 2229 BM (57%)]. The overall rate of office visits (2386 vs. 2391 per 100 women, p = 0.42) and hospital readmission rate (29.1 per 100 women vs. 27.4, p = 0.06) were similar between BM + IBR and UM + IBR. Women undergoing BM + IBR had a higher emergency room (ER) visit rate (34.1 per 100 women vs. 29.8, p < 0.0001). The total 2-year cost of care was higher for BM + IBR than UM + IBR for implant reconstruction ($106,711 vs. $97,218, p < 0.0001) and for autologous reconstruction ($114,725 vs. $87,874, p < 0.0001).

Conclusions

BM + IBR (autologous or implant) was associated with increased ER visits and higher total cost of care over 2 years compared with UM + IBR. Patients considering CPM should be counseled on the additional risks and costs associated with BM + IBR.

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Disclosures

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Judy C. Boughey MD, Lin Zhu MD, Elizabeth B. Habermann PhD & Valerie Lemaine MD

  2. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Stephanie R. Schilz BA

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Holly K. Van Houten BA

  4. The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Elizabeth B. Habermann PhD

  5. OptumLabs, Cambridge, MN, USA

    Holly K. Van Houten BA

Authors
  1. Judy C. Boughey MD
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  2. Stephanie R. Schilz BA
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  3. Holly K. Van Houten BA
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  4. Lin Zhu MD
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  5. Elizabeth B. Habermann PhD
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  6. Valerie Lemaine MD
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Corresponding author

Correspondence to Judy C. Boughey MD.

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Boughey, J.C., Schilz, S.R., Van Houten, H.K. et al. Contralateral Prophylactic Mastectomy with Immediate Breast Reconstruction Increases Healthcare Utilization and Cost. Ann Surg Oncol 24, 2957–2964 (2017). https://doi.org/10.1245/s10434-017-5983-3

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  • DOI: https://doi.org/10.1245/s10434-017-5983-3

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