by Billig,
Jessica I.; Duncan, Anthony; Zhong, Lin; Aliu, Oluseyi; Sears, Erika D.; Chung,
Kevin C.; Momoh, Adeyiza O.
Background:
Contralateral prophylactic mastectomy may be unnecessary from an oncologic
perspective; therefore, the debate persists about the value of contralateral
prophylactic mastectomy in women with early-stage unilateral breast cancer.
Given finite health care resources, this study aims to evaluate the cost of
contralateral prophylactic mastectomy and breast reconstruction. Methods: Women
with unilateral breast cancer undergoing either unilateral mastectomy or
unilateral mastectomy with contralateral prophylactic mastectomy and immediate
breast reconstruction were selected from the Truven MarketScan databases
between 2009 and 2013. Demographic and treatment data were recorded, and over
an 18-month follow-up period, the treatment cost was tallied. A log-transformed
linear model was used to compare cost between the groups. Results: A total of
2343 women were identified who met our inclusion criteria, with 1295 undergoing
unilateral mastectomy and 1048 undergoing contralateral prophylactic
mastectomy. Complication rates within 18 months were similar for women
undergoing unilateral mastectomy and contralateral prophylactic mastectomy (39
percent versus 42 percent; p = 0.17). Management with unilateral mastectomy
with reconstruction required an adjusted cumulative mean cost of $33,557.
Contralateral prophylactic mastectomy with reconstruction was an additional
$11,872 in expenditure (p < 0.001). The cost of initial procedures (mean
difference, $6467) and secondary procedures (mean difference, $2455) were the
greatest contributors to cost. Conclusions: In women with unilateral breast
cancer, contralateral prophylactic mastectomy with reconstruction is more costly.
The increased monetary cost of contralateral prophylactic mastectomy may be
offset by improved quality of life. However, this financial reality is an
important consideration when ongoing efforts toward reimbursement reform may
not pay for contralateral prophylactic mastectomy if outcomes data are not
presented to justify this procedure.
