Economic evaluation of breast cancer treatment: considering the value of patient choice.
OBJECTIVE
To use 5 years of primary data to compare the incremental cost-effectiveness of breast conservation and radiation versus mastectomy with the restriction of choice to a single therapy versus providing a choice of either therapy.


METHODS
We evaluated a random retrospective cohort of 2,517 Medicare beneficiaries treated for newly diagnosed stage I or II breast cancer from 1992 through 1994. The outcome measures were quality-adjusted life-years (QALYs) and 5-year medical costs. Risk and propensity score adjustments were used in the analysis.


RESULTS
A breast conservation and radiation regimen has significantly higher costs than mastectomy in the first year after surgery; the adjusted 5-year costs are $14,054 (95% confidence interval, $9,791 to $18,312) greater than those of mastectomy. The adjusted incremental cost-effectiveness ratio comparing breast conservation and radiation to mastectomy was $219,594 per QALY for the comparison of the two strategies. If the possibility of patient choice from maintaining the availability of multiple treatments versus restricting choice to mastectomy alone provides a quality-of-life gain of 0.031 QALYs, then the cost-effectiveness ratio of this choice option is $80,440 per QALY.


CONCLUSIONS
The current system of providing a choice between mastectomy and breast conservation surgery is economically attractive when the economic analysis includes the benefit of patient choice of treatment.
Polsky
Daniel
D
University of Pennsylvania, Philadelphia, PA 19104-6021, USA. polsky@mail.med.upenn.edu
Mandelblatt
Jeanne S
JS
Weeks
Jane C
JC
Venditti
Laura
L
Hwang
Yi-Ting
YT
Glick
Henry A
HA
Hadley
Jack
J
Schulman
Kevin A
KA
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008408:Mastectomy / Q000191:economics* / Q000379:methods; D015412:Mastectomy, Segmental / Q000191:economics; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000191:economics* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010358:Patient Participation / Q000191:economics*; D019057:Quality-Adjusted Life Years; D018714:Radiotherapy, Adjuvant / Q000191:economics; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States