Cost and Complications of Local Therapies for Early-Stage Breast Cancer.
Guideline-concordant local therapy options for early breast cancer include lumpectomy plus whole breast irradiation (Lump+WBI), lumpectomy plus brachytherapy, mastectomy alone, mastectomy plus reconstruction, and, in older women, lumpectomy alone. We performed a comparative examination of each treatment's complications and cost to assess their relative values.



Using the MarketScan database of younger women with private insurance and the SEER-Medicare database of older women with public insurance, we identified 105 211 women with early breast cancer diagnosed between 2000 and 2011. We used diagnosis and procedural codes to identify treatment complications within 24 months of diagnosis and compared complications by treatment using two-sided logistic regression. Mean total and complication-related cost, relative to Lump+WBI, were calculated from a payer's perspective and adjusted for differences in covariables using linear regression. All statistical tests were two-sided.



Lump+WBI was the most commonly used treatment. Mastectomy plus reconstruction was associated with nearly twice the complication risk of Lump+WBI (Marketscan: 54.3% vs 29.6%, relative risk [RR] = 1.87, 95% confidence interval [CI] = 1.82 to 1.91, P < .001; SEER-Medicare: 66.1% vs 37.6%, RR = 1.75, 95% CI = 1.69 to 1.82, P < .001) and was also associated with higher adjusted total cost (Marketscan: $22 481 greater than Lump+WBI; SEER-Medicare: $1748 greater) and complication-related cost (Marketscan: $9017 greater; SEER-Medicare: $2092 greater). Brachytherapy had modestly higher total cost and complications than WBI. Lumpectomy alone entailed lower cost and complications in the SEER-Medicare cohort only.



Mastectomy plus reconstruction results in substantially higher complications and cost than other guideline-concordant treatment options for early breast cancer. These findings are relevant to patients evaluating their local therapy options and to value-based population health management.
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Benjamin D
BD
Smith
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Jing
J
Jiang
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Ya-ChenTina
YC
Shih
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Sharon H
SH
Giordano
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Jinhai
J
Huo
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Reshma
R
Jagsi
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Adeyiza O
AO
Momoh
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Abigail S
AS
Caudle
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Kelly K
KK
Hunt
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Simona F
SF
Shaitelman
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Thomas A
TA
Buchholz
Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS).
Shervin M
SM
Shirvani
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