Cost-effectiveness of contralateral prophylactic mastectomy for prevention of contralateral breast cancer

Amanda Roberts, Mehran Habibi, Kevin Frick

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)2209-2217
Number of pages9
JournalAnnals of Surgical Oncology
Volume21
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Cost-Benefit Analysis
Breast Neoplasms
Costs and Cost Analysis
Mastectomy
Quality-Adjusted Life Years
Fee Schedules
Decision Trees
Health
Medicare
Prophylactic Mastectomy
Breast
Software
Delivery of Health Care
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

Cost-effectiveness of contralateral prophylactic mastectomy for prevention of contralateral breast cancer. / Roberts, Amanda; Habibi, Mehran; Frick, Kevin.

In: Annals of Surgical Oncology, Vol. 21, No. 7, 2014, p. 2209-2217.

Research output: Contribution to journalArticle

@article{8e0de6064e69455c8ebe11f69c42f650,
title = "Cost-effectiveness of contralateral prophylactic mastectomy for prevention of contralateral breast cancer",
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.",
author = "Amanda Roberts and Mehran Habibi and Kevin Frick",
year = "2014",
doi = "10.1245/s10434-014-3588-7",
language = "English (US)",
volume = "21",
pages = "2209--2217",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",
number = "7",

}

TY - JOUR

T1 - Cost-effectiveness of contralateral prophylactic mastectomy for prevention of contralateral breast cancer

AU - Roberts, Amanda

AU - Habibi, Mehran

AU - Frick, Kevin

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84902211888&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902211888&partnerID=8YFLogxK

U2 - 10.1245/s10434-014-3588-7

DO - 10.1245/s10434-014-3588-7

M3 - Article

C2 - 24633665

AN - SCOPUS:84902211888

VL - 21

SP - 2209

EP - 2217

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 7

ER -