Abstract
Background
The aim was to evaluate the cost-utility of four common surgical treatment pathways
for breast cancer: mastectomy, breast-conserving therapy (BCT), implant breast reconstruction
(BR) and autologous-BR.
Methods
Patient-level healthcare consumption data and results of a large quality of life (QoL)
study from five Dutch hospitals were combined. The cost-effectiveness was assessed
in terms of incremental costs and quality adjusted life years (QALYs) over a 10-year
follow-up period. Costs were assessed from a healthcare provider perspective.
Results
BCT resulted in comparable QoL with lower costs compared to implant-BR and autologous-BR
and showed better QoL with higher costs than mastectomy (€17,246/QALY). QoL outcomes
and costs of especially autologous-BR were affected by the relatively high occurrence
of complications. If reconstruction following mastectomy was performed, implant-BR
was more cost-effective than autologous-BR.
Conclusion
The occurrence of complications had a substantial effect on costs and QoL outcomes
of different surgical pathways for breast cancer. When this was taken into account,
BCT was most the cost-effective treatment. Even with higher costs and a higher risk
of complications, implant-BR and autologous-BR remained cost-effective over mastectomy.
This pleas for adapting surgical pathways to individual patient preferences in the
trade-off between the risks of complications and expected outcomes.
Keywords
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Article info
Publication history
Published online: November 28, 2020
Accepted:
November 20,
2020
Identification
Copyright
© 2020 Published by Elsevier Ltd.
