title: Economic Implications of Widespread Expansion of Frozen Section Margin Analysis to Guide Surgical Resection in Women With Breast Cancer Undergoing Breast-Conserving Surgery.
abstract: OBJECTIVE
  In the current health care environment, cost effectiveness is critically important in policy setting and care of patients. This study performed a health economic analysis to assess the implications to providers and payers of expanding the use of frozen section margin analysis to minimize reoperations for patients undergoing breast cancer lumpectomy.
  
  
  METHODS
  A health care economic impact model was built to assess annual costs associated with breast lumpectomy procedures with and without frozen section margin analysis to avoid reoperation.
  
  
  RESULTS
  If frozen section margin analysis is used in 20% of breast lumpectomies and under a baseline assumption that 35% of initial lumpectomies without frozen section analysis result in reoperations, the potential annual cost savings are $18.2 million to payers and $0.4 million to providers. Under the same baseline assumption, if 100% of all health care facilities adopted the use of frozen section margin analysis for breast lumpectomy procedures, the potential annual cost savings are $90.9 million to payers and $1.8 million to providers. On the basis of 10,000 simulations, use of intraoperative frozen section margin analysis yields cost saving for payers and is cost neutral to slightly cost saving for providers.
  
  
  CONCLUSIONS
  This economic analysis indicates that widespread use of frozen section margin evaluation intraoperatively to guide surgical resection in breast lumpectomy cases and minimize reoperations would be beneficial to cost savings not only for the patient but also for payers and, in most cases, for providers.
authors.affiliation: Mayo Clinic, Rochester, MN; and McDermott+Consulting, Washington, DC boughey.judy@mayo.edu.
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.affiliation: Mayo Clinic, Rochester, MN; and McDermott+Consulting, Washington, DC.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Keeney
authors.affiliation: Mayo Clinic, Rochester, MN; and McDermott+Consulting, Washington, DC.
authors.forename: Paul
authors.initials: P
authors.lastname: Radensky
authors.affiliation: Mayo Clinic, Rochester, MN; and McDermott+Consulting, Washington, DC.
authors.forename: Christine P
authors.initials: CP
authors.lastname: Song
authors.affiliation: Mayo Clinic, Rochester, MN; and McDermott+Consulting, Washington, DC.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D000066491:Clinical Decision-Making; D003362:Cost-Benefit Analysis; D005260:Female; D005629:Frozen Sections / Q000191:economics* / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D000072662:Margins of Excision; D015412:Mastectomy, Segmental / Q000379:methods; D017059:Models, Econometric; D009010:Monte Carlo Method; D012086:Reoperation