title: Economic Impact of Routine Cavity Margins Versus Standard Partial Mastectomy in Breast Cancer Patients: Results of a Randomized Controlled Trial.
abstract: The aim of the study was to compare costs associated with excision of routine cavity shave margins (CSM) versus standard partial mastectomy (PM) in patients with breast cancer.
  
  
  
  Excision of CSM reduces re-excision rates by more than 50%. The economic implications of this is, however, unclear.
  
  
  
  Between October 21, 2011 and November 25, 2013, 235 women undergoing PM for Stage 0-III breast cancer were randomized to undergo either standard PM ("no shave", n = 116) or have additional CSM taken ("shave", n = 119). Costs from both a payer and a hospital perspective were measured for index surgery and breast cancer surgery-related care through subsequent 90 days.
  
  
  
  The 2 groups were well-matched in terms of baseline characteristics. Those in the "shave" group had a longer operative time at the initial surgery (median 76 vs 66 min, P < 0.01), but a lower re-excision rate for positive margins (13/119 = 10.9% vs 32/116 = 27.6%, P < 0.01). Actual direct hospital costs associated with operating room time ($1315 vs. $1137, P = 0.03) and pathology costs ($1195 vs $795, P < 0.01) were greater for the initial surgery in patients in the "shave" group. Taking into account the index surgery and the subsequent 90 days, there was no significant difference in cost from either the payer ($10,476 vs $11,219, P = 0.40) or hospital perspective ($5090 vs $5116, P = 0.37) between the "shave" and "no shave" groups.
  
  
  
  Overall costs were not significantly different between the "shave" and "no shave" groups due to significantly fewer reoperative surgeries in the former.
authors.affiliation: *Department of Surgery, Yale University †Yale Cancer Center ‡Yale Center for Outcomes Public Policy and Effectiveness Research §Department of Surgery, Thomas Jefferson University ¶Yale-New Haven Hospital ||Yale Center for Analytical Sciences **Department of Pathology, Yale University ††Department of Medicine, Yale University.
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.forename: Nina R
authors.initials: NR
authors.lastname: Horowitz
authors.forename: Brigid K
authors.initials: BK
authors.lastname: Killelea
authors.forename: Theodore
authors.initials: T
authors.lastname: Tsangaris
authors.forename: Peter
authors.initials: P
authors.lastname: Longley
authors.forename: Sonia
authors.initials: S
authors.lastname: Grizzle
authors.forename: Michael
authors.initials: M
authors.lastname: Loftus
authors.forename: Fangyong
authors.initials: F
authors.lastname: Li
authors.forename: Meghan
authors.initials: M
authors.lastname: Butler
authors.forename: Karen
authors.initials: K
authors.lastname: Stavris
authors.forename: Xiaopan
authors.initials: X
authors.lastname: Yao
authors.forename: Malini
authors.initials: M
authors.lastname: Harigopal
authors.forename: Veerle
authors.initials: V
authors.lastname: Bossuyt
authors.forename: Donald R
authors.initials: DR
authors.lastname: Lannin
authors.forename: Lajos
authors.initials: L
authors.lastname: Pusztai
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000191:economics / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000191:economics / Q000601:surgery; D018275:Carcinoma, Lobular / Q000191:economics / Q000601:surgery; D003237:Connecticut; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D000072662:Margins of Excision; D015412:Mastectomy, Segmental / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D016037:Single-Blind Method; D016896:Treatment Outcome