Scripties UMCG - Rijksuniversiteit Groningen
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Cost-Analysis for Oncoplastic Lumpectomy and Mastectomy combined with Tissue-Expanding techniques: which is less expensive?

(2018) Wilmer, T.J.K.

Introduction: Breast conserving surgery is gaining in popularity, especially with the introduction of oncoplastic lumpectomy. Although results in terms of less complications and superior PROM's are known for oncoplastic lumpectomy, no evidence about costs of oncoplastic lumpectomy are available compared to the frequently used technique of mastectomy combined with a TE + SI.
Material & Methods: A cost-analysis comparing oncoplastic lumpectomy and mastectomy combined with TE/SI has been performed, according to the guidelines of the NZa. Patients were followed 18 months after the initial surgical procedure. Statistical analysis has been performed by using Chi-Square, Fisher's Exact and Mann Whitney-U tests. Complications of both groups are secondary outcome and qualitatively compared to each other.
Results: Median costs for oncoplastic lumpectomy are €13047 (€11638 - €15322) compared to €10848 (€9579 - €14010) in the mastectomy + TE/SI. Surgical costs for explanting an implant are €2146 ( €1244 - €2826). 26,7% of the mastectomy patients had a grade III complication, 8 patients underwent an explantation of the TE. In the oncoplastic group, only 2 patients had to undergo surgical treatment for a complication.
Conclusion: Oncoplastic Lumpectomy is the more expensive treatment, however it should be kept in mind that costs for the mastectomy +TE/SI group will raise in the future, because implants will not last a lifetime. In the tendency of value-based healthcare it should be reconsidered that oncoplastic lumpectomy could be the superior treatment in terms of costs over a longer period: follow-up studies will be needed for providing more evidence. Additionally, this study also shows how costs could be used for finding complicated patients and therefore could be useful in clinical auditing.

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