Abstract
BackgroundBoth breast-conserving surgery and breast reconstruction surgery are less popular in China, although they can improve patients’ quality of life. The main reason comes from the economy. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aims to assess the economic impact and long-term cost-effectiveness of different surgical treatments for early breast cancer. The surgical approaches are including mastectomy (MAST), breast-conserving therapy (BCT), and mastectomy with reconstruction (MAST+RECON).MethodsBased on demographic data, disease-related information and other treatments, we applied propensity score matching (PSM) to perform 1: 1 matching among patients who underwent these three types of surgery in the tertiary academic medical center from 2011 to 2017 to obtain a balanced sample of covariates between groups. A Markov model was established. Clinical data and cost data were obtained from the medical records. Health utility values were derived from clinical investigations. Strategies were compared using an incremental cost-effectiveness ratio (ICER).ResultsAfter PSM, there were 205 cases in each group. In the matched data set, the distribution of covariates was fully balanced. The total cost of MAST, MAST+RECON and BCT was $37,392.84, $70,556.03 and $82,330.97, respectively. The quality-adjusted life year (QALYs) were 17.11, 18.40 and 20.20, respectively. Compared with MAST, MAST+RECON and BCT have an ICER of $25,707.90/QALY and $14,543.08/QALY, respectively. The ICER of BCT vs. MAST was less than the threshold of $27,931.04. The reliability and stability of the results were confirmed by Monte Carlo simulation and sensitivity analysis.ConclusionsWe believe that in the context of the limited resources in China, after comparing the three surgical approaches, BCT is the more cost-effective and preferred solution.
Highlights
Both breast-conserving surgery and breast reconstruction surgery are less popular in China, they can improve patients’ quality of life
Studies by Barlow et al [11] have found that breast-conserving therapy may have higher short-term costs but lower long-term costs compared to mastectomy
Taking MAST + RECON as the reference group, the propensity score matching method was used for individual matching between groups
Summary
Both breast-conserving surgery and breast reconstruction surgery are less popular in China, they can improve patients’ quality of life. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aims to assess the economic impact and long-term cost-effectiveness of different surgical treatments for early breast cancer. Surgery is the main method of treating early breast cancer. A number of studies have shown that for early breast cancer, there is no statistically significant difference in disease-free survival and overall survival between the breast-conserving surgery plus radiotherapy group and the mastectomy group [5,6,7]. Breast-conserving therapy and breast reconstruction have increased the costs of treatment while improving the quality of life [9, 10]. Most studies believe that breast-conserving therapy and breast reconstruction have higher costs, some studies have reached inconsistent conclusions, and evidence from China is lacking
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