[Variability and opportunity costs among the surgical alternatives for breast cancer].
OBJECTIVE
To analyze medical practice variation in breast cancer surgery (either inpatient-based or day-case surgery), by comparing conservative surgery (CS) plus radiotherapy vs. non-conservative surgery (NCS). We also analyzed the opportunity costs associated with CS and NCS.


METHODS
We performed an observational study of age- and sex-standardized rates of CS and NCS, performed in 199 Spanish healthcare areas in 2008-2009. Costs were calculated by using two techniques: indirectly, by using All-Patients Diagnosis Related Groups (AP-DRG) based on hospital admissions, and directly by using full costing from the Spanish Network of Hospital Costs (SNHC) data.


RESULTS
Standardized surgery rates for CS and NCS were 6.84 and 4.35 per 10,000 women, with variation across areas ranging from 2.95 to 3.11 per 10,000 inhabitants. In 2009, 9% of CS was performed as day-case surgery, although a third of the health care areas did not perform this type of surgery. Taking the SNHC as a reference, the cost of CS was estimated at 7,078 € and that of NCS was 6,161 €. Using AP-DRG, costs amounted to 9,036 € and 8,526 €, respectively. However, CS had lower opportunity costs than NCS when day-case surgery was performed frequently-more than 46% of cases (following SNHC estimates) or 23% of cases (following AP-DRG estimates).


CONCLUSIONS
Day-case CS for breast cancer was found to be the best option in terms of opportunity-costs beyond a specific threshold, when both CS and NCS are elective.
Unidad de Investigación en Políticas y Servicios Sanitarios, Instituto Aragonés de Ciencias de la Salud, ISS Aragón, Zaragoza, España. Electronic address: eangulop.iacs@aragon.es.
Ester
E
Angulo-Pueyo
Unidad de Investigación en Políticas y Servicios Sanitarios, Instituto Aragonés de Ciencias de la Salud, ISS Aragón, Zaragoza, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, España.
Manuel
M
Ridao-López
Unidad de Investigación en Políticas y Servicios Sanitarios, Instituto Aragonés de Ciencias de la Salud, ISS Aragón, Zaragoza, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España.
Natalia
N
Martínez-Lizaga
Unidad de Investigación en Políticas y Servicios Sanitarios, Instituto Aragonés de Ciencias de la Salud, ISS Aragón, Zaragoza, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España.
Sandra
S
García-Armesto
Unidad de Investigación en Políticas y Servicios Sanitarios, Instituto Aragonés de Ciencias de la Salud, ISS Aragón, Zaragoza, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España.
Enrique
E
Bernal-Delgado
D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics*; D055815:Young Adult
Análisis de áreas pequeñas; Asignación de costes; Breast neoplasms; Cirugía conservadora; Clinical practice variation; Cost allocation; Costes sanitarios; Cáncer de mama; Health care costs; Mastectomy; Mastectomía; Segmental mastectomy; Small-area analysis; Variabilidad de la práctica médica