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Incremental Spending Associated with Low-Value Treatments in Older Women with Breast Cancer

Abstract

Background

In most women ≥ 70 years old with hormone-receptor-positive breast cancer, axillary staging and adjuvant radiotherapy provide no survival advantage over surgery and hormone therapy alone. Despite recommendations for their omission, sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy rates remain high. While treatment side effects are well documented, less is known about the incremental spending associated with SLNB and adjuvant radiotherapy.

Methods

Using a statewide multipayer claims registry, we examined spending associated with breast cancer treatment in a retrospective cohort of women ≥ 70 years old undergoing surgery.

Results

9074 women ≥70 years old underwent breast cancer resection between 2012 and 2019, with 78% (n = 7122) receiving SLNB and/or adjuvant radiotherapy within 90 days of surgery. Women undergoing SLNB were more likely to receive radiation (51% vs. 28%; p < 0.001 and OR = 2.68). Average 90-day spending varied substantially based upon treatment received, ranging from US$10,367 (breast-conserving surgery alone) to US$27,370 (mastectomy with SLNB and adjuvant radiotherapy). The relative increases in 90-day treatment spending in the breast-conserving surgery cohort was 65% for SLNB, 82% for adjuvant radiotherapy, and 120% for both treatments.

Conclusions

SLNB and adjuvant radiotherapy have significant spending implications in older women with breast cancer, even though they are unlikely to improve survival.

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Acknowledgments

The Michigan Value Collaborative (MVC) is supported by Blue Cross Blue Shield of Michigan (BCBSM). The funding agency was not involved in the design, analysis, or reporting of this study.

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Correspondence to Lesly A. Dossett MD, MPH.

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Disclosures

Dr. Dossett is supported by a grant from the Agency for Healthcare Research and Quality (AHRQ; 5 K08 HS026030-02). Dr. Bredbeck is supported by the Ruth L. Kirschstein Research Service Award from the National Cancer Institute (NCI; T32 CA009672). Dr. Baskin is supported by scholarship funding from the University of Michigan Rogel Cancer Center. Dr. Berlin receives funding from the US Department of Veterans Affairs supporting his role as a National Clinician Scholar. Dr. Nathan is supported by a contract from Blue Cross Blue Shield of Michigan Value Partnerships program for the conduct of the Michigan Value Collaborative.

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Bredbeck, B.C., Baskin, A.S., Wang, T. et al. Incremental Spending Associated with Low-Value Treatments in Older Women with Breast Cancer. Ann Surg Oncol (2021). https://doi.org/10.1245/s10434-021-10807-3

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