Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction.
BACKGROUND
Breast conservation surgery (BCS), consisting of lumpectomy, axillary lymph node dissection, and radiation therapy, is as effective as modified radical mastectomy (MRM) for the treatment of early stage breast cancer. The costs of these treatment options have not been adequately addressed in the current era of increasing utilization of BCS and breast reconstruction. The purpose of this study is to determine differences in treatment costs among BCS, MRM alone, and MRM with reconstruction.


METHODS
Patients with stage I and II breast cancer receiving inpatient treatment at a private university-affiliated hospital between January 1996 and July 1997 were analyzed (n = 230). Charges were determined as follows: inpatient and radiotherapy charges from the hospital billing department, surgeon fees from group practice billing codes, and radiotherapy physician fees from the radiation oncology group practice. Inpatient length of stay was obtained from hospital medical records.


RESULTS
Average hospital inpatient charge for BCS was $4,748 (n = 74), $6,280 for MRM alone (P <0.001, n = 132), and $11,946 for MRM with reconstruction (P <0.001, n = 24). Surgeons' fees for BCS were $2,840, $3,500 for MRM alone, and $10,774 for MRM with reconstruction. The average radiotherapy charge was $18,742. Average length of stay was 1.03 days for BCS, 2.44 days for MRM alone (P <0.001), and 3.71 days for MRM with reconstruction (P <0. 001). Average total cost of BCS ($26,330) was significantly greater than the average total cost of either MRM alone ($9,780, P <0.001) or MRM with reconstruction ($22,720, P <0.001).


CONCLUSIONS
BCS is more expensive than MRM with or without reconstruction. It is the addition of radiotherapy that results in the higher total cost of CS.
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Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
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Brunicardi
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D003365:Costs and Cost Analysis; D005069:Evaluation Studies as Topic; D005251:Fees, Medical / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D015409:Mastectomy, Radical / Q000191:economics* / Q000379:methods; D015412:Mastectomy, Segmental / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D012042:Registries; D012680:Sensitivity and Specificity; D013781:Texas