title: Healthcare Costs Reduced After Incorporating the Results of the American College of Surgeons Oncology Group Z0011 Trial into Clinical Practice.
abstract: The purpose of our study was to quantitate the changes in axillary lymph node dissection (ALND), frozen section (FS), and the impact on costs after the publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial. We compared axillary nodal management and cost data in breast cancer patients who met Z0011 criteria and were treated with lumpectomy and sentinel lymph nodes (SLN) biopsy from 2007 to July 2013. Of 800 patients, 67 (13.5%) and 34 (12.5%) patients in the pre- and post-Z0011 era had 1-2 positive SLN. ALND decreased from 78% to 21% (p < 0.001) after publication of Z0011. The mean overall cost of SLN biopsy was $41,059 per patient, while SLN biopsy with completion ALND was $50,999 (p < 0.001). Intraoperative FS use decreased from 95% to 66% (p = 0.015). Omitting the FS decreased mean costs from $4,319 to $2,036. The application of Z0011 resulted in an overall mean cost savings of $571,653 from 2011 to July 2013. ACOSOG Z0011 significantly impacted axillary management resulting in a 20% reduction in the mean overall cost per patient by omitting ALND. In these patients, intraoperative FS analysis had poor sensitivity (56%) and doubled the cost of pathologic examination. Fewer ALND and intraoperative FS were performed after the publication of ACOSOG Z0011. Eliminating FS and ALND in patients who met Z0011 criteria, results in significant cost savings.
authors.affiliation: Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.|Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.|Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Fillion
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Glass
authors.affiliation: The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Joe
authors.initials: J
authors.lastname: Hayek
authors.affiliation: Center for Biostatistics, The Ohio State University, Columbus, Ohio.
authors.forename: Allison
authors.initials: A
authors.lastname: Wehr
authors.affiliation: Center for Biostatistics, The Ohio State University, Columbus, Ohio.
authors.forename: Gary
authors.initials: G
authors.lastname: Phillips
authors.affiliation: Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.|Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Alicia
authors.initials: A
authors.lastname: Terando
authors.affiliation: Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.|Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Doreen M
authors.initials: DM
authors.lastname: Agnese
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000191:economics; D002986:Clinical Trials as Topic; D005260:Female; D005629:Frozen Sections; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision / Q000191:economics*; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009820:Ohio; D000072103:Oncologists; D010818:Practice Patterns, Physicians' / Q000191:economics*; D021701:Sentinel Lymph Node Biopsy / Q000191:economics; D014481:United States
keywords: Z0011; breast cancer; cost; frozen section