Abstract
BackgroundGrowing demand for risk-reducing surgery in individuals with inherited susceptibility to cancer leads to the question whether these procedures are cost effective for the executing hospitals. This study compared the clinical costs for bilateral risk-reducing mastectomy (BRRM) with and without different types of reconstruction, risk-reducing salpingo-oophorectomy (RRSO), and their combinations with corresponding reimbursements in the statutory health-care system in Germany.Patients and methodsReal total costs of care for BRRM with and without reconstruction, RRSO, and their combinations were calculated as the sum of all personnel and technical costs. These costs calculated in a German University hospital were compared with the sum of all reimbursements in the German DRG-based health-care system.ResultsWhile sole RRSO, BRRM without reconstruction, and BRRM with secondary DIEP (deep inferior epigastric perforator)—reconstruction still result in a small benefit, we even found shortfalls for the hospital with all other prophylactic operations under consideration. The calculated deficits were especially high for BRRM with implant-based breast reconstruction and for combined operations when the risk reduction is achieved with a minimum of separate operations.ConclusionsRisk-reducing surgery in BRCA-mutation carriers is frequently not cost-covering for the executing hospitals in the German health-care system. Thus, appropriate concepts are required to ensure a nationwide care.
Highlights
Growing demand for risk-reducing surgery in individuals with inherited susceptibility to cancer leads to the question whether these procedures are cost effective for the executing hospitals
The majority of patients currently diagnosed with breast cancer (BC) or ovarian cancer (OC) have a sporadic form of the disease
Patient characteristics Between 2009 and 2013, 370 individuals were seen at the interdisciplinary Breast and Ovarian Cancer Genetics Clinic at the University Breast Center for Franconia
Summary
Growing demand for risk-reducing surgery in individuals with inherited susceptibility to cancer leads to the question whether these procedures are cost effective for the executing hospitals. The breast cancer 1 (BRCA1) gene, identified in 1994, and BRCA 2, identified in 1995, are the best known genetic risk factors for heritable breast cancer (BC) and ovarian cancer (OC) [1,2,3,4,5]. Heterozygous germline mutations in either BRCA1 or BRCA2 or other moderately to highly penetrant risk genes are responsible for about 5–10% of all cases of BC [6,7,8,9]. In interdisciplinary Breast and Ovarian Cancer Genetics Clinics, different medical departments (gynecology, genetics, radiology, and psycho-oncology) collaborate in the effort to optimize evaluation and consultation for patients with positive family history or proven hereditary BC and OC.
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