A Systematic Review of Utility Score Assessments in the Breast Surgery Cost-Analysis Literature
- 190 Downloads
Surgery for breast cancer can have significant impact on patient quality-of-life. Cost-utility analysis provides a way to analyze the economic impact of a surgical procedure with the change in a patient’s quality of life. Utility scores are used in these analyses to quantify the impact on quality of life. We undertook a systematic review of the literature on breast cancer surgical procedures to compile a repository of utility scores and to assess gaps in the current literature.
Following PRISMA guidelines, a systematic review was performed for studies reporting utility scores for breast surgery and breast reconstruction. The health states and utility scores were extracted and grouped into seven procedural categories based on oncologic and reconstructive methods. Mean utility score and ranges were calculated and reported for each procedural category.
Nineteen articles met the inclusion criteria assessing 118 health states. Most utility scores were obtained from healthcare professionals. Breast-conserving therapy yielded the highest mean utility score at 0.79, whereas mastectomy yielded a mean utility score of 0.75. Among reconstruction health states, implant reconstruction had a lower score than autologous reconstruction (0.64 implant vs. latissimus dorsi 0.69 and TRAM/DIEP 0.71). No utility scores were found associated with oncoplasty or nipple-sparing mastectomy procedures.
A reliable body of utility scores is important in enabling future cost-utility and value-based analysis comparisons for breast surgical oncology. Additional work is needed to obtain health state assessments from the patient perspective, as well as assessment of more modern surgical and reconstructive approaches.
No conflicts of interest and no commercial interests by any of the authors involved in the article.
- 1.Group USCSW. United States Cancer Statistics: 1999–2014 incidence and mortality web-based report. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2017.Google Scholar
- 16.Blank MM, Papageorge M, Chen L, et al. Hidden bias in cost-analysis research: what is the prevalence of under-reporting cost perspective in the general surgical literature? J Am Coll Surg. 2017;225:823–828.Google Scholar
- 30.Mansel R, Locker G, Fallowfield L, et al. Cost-effectiveness analysis of anastrozole vs tamoxifen in adjuvant therapy for early stage breast cancer in the United Kingdom: the 5-year completed treatment analysis of the ATAC (‘Arimidex’, Tamoxifen alone or in combination) trial. Br J Cancer. 2007;97:152–61.CrossRefGoogle Scholar
- 32.Prescott RJ, Kunkler IH, Williams LJ, et al. A randomised controlled trial of postoperative radiotherapy following breast-conserving surgery in a minimum-risk older population. The PRIME trial. Health Technol Assess. 2007;11:1-149, 3–4.Google Scholar