title: Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins.
abstract: BACKGROUND
  Negative margins are associated with decreased local recurrence after lumpectomy for breast cancer. A 2nd operation for re-excision of positive margins is required with rates varying from 15 to 50%. At our institution we routinely use frozen-section analysis of all margins to minimize rates of 2nd operations. The aim of this study was to evaluate the cost/benefit of routine frozen-section analysis.
  
  
  METHODS
  A decision tree was built to compare 2 strategies: (A) lumpectomy without frozen section and a 2nd operation for positive margin(s) versus (B) lumpectomy with intraoperative frozen-section analysis and a 2nd operation for positive margin(s). For strategy A the rate of positive margins and reoperation were varied from 15 to 50%. For strategy B, a 2nd operation rate of 3% was used. Review of our institutional experience demonstrates an intraoperative re-excision of at least 1 margin in 57% of cases performed with frozen-section support.
  
  
  RESULTS
  The cost to provider (i.e., institution) per patient resected to negative margins for strategy A ranged from $4835 to $6306. Average weighted cost of strategy B was $5708. Strategy B was less expensive when the reoperation rate was above 36%. The cost to payor (i.e., Medicare) for strategy A ranged from $3577 to $4665. Average weighted cost for strategy B was $3913. Strategy B was less expensive when the re-excision rate was above 26%.
  
  
  CONCLUSIONS
  Routine use of frozen-section analysis of lumpectomy margins decreases reoperation rates for margin control; therefore, the cost to provider and payor can be cost effective.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Osborn
authors.forename: Gary L
authors.initials: GL
authors.lastname: Keeney
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
mesh_terms: D001943:Breast Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D005629:Frozen Sections; D006801:Humans; D015412:Mastectomy, Segmental / Q000191:economics*; D009364:Neoplasm Recurrence, Local / Q000191:economics* / Q000517:prevention & control; D011379:Prognosis; D012086:Reoperation / Q000191:economics*; D024162:Second-Look Surgery