Margin Re-excision and Local Recurrence in Invasive Breast Cancer: A Cost Analysis Using a Decision Tree Model
Margin Re-excision and Local Recurrence in Invasive Breast Cancer: A Cost Analysis Using a Decision Tree Model
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DOI：
10.1002/jso.23990
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发表时间：
2015-09-15
影响因子：
2.5
通讯作者：
White, Richard L., Jr.
中科院分区：
文献类型：
--
作者：
Abe, Shoko E.;Hill, Joshua S.;White, Richard L., Jr.
背景：SSO-ASTRO 最近发布的指南将保乳治疗 (BCT) 中的足够切缘定义为墨水上无肿瘤，研究表明局部复发 (LR) 与较宽切缘的差异不大。我们假设，不定期重新切除近距离切缘会在不影响护理的情况下降低成本。方法：开发决策树模型用于浸润性癌症 BCT 后的切缘管理。对患者进行了三个切缘状态组的比较：阳性、接近（2 毫米）。十份出版物提供了再切除率 (RER) 和 LR 率。该模型假设每年有 140,000 BCT。敏感性分析确定了最具成本效益的策略。手术费用是根据 2013 年 Medicare 报销率估算的。结果：在美国，重新切除接近利润的费用明显高于替代方案，分别为 2.331 亿美元和 2.143 亿美元。总手术成本对近距离切缘的重新切除最敏感 - 将 RER 从 0% 增加到 100% 会导致 1880 万美元的成本差异。结论：重新切除近距离切缘的策略导致每年预计成本为 1880 万美元。这不包括医院费用、再次切除后手术并发症的费用，并且低估了使用医疗保险报销率可能节省的费用。 (c) 2015 年 Wiley 期刊公司。
Background: SSO-ASTRO recently published guidelines defining adequate margins in breast conservation therapy (BCT) as no tumor on ink based on studies demonstrating little difference in local recurrence (LR) with wider margins. We hypothesize that not routinely re-excising close margins results in decreased costs without compromising care.Methods: Adecision tree model was developed for the management of margins after BCT for invasive cancer. Patients were compared among three margin status groups: positive, close ( 2 mm). Ten publications provided re-excision rates (RER) and LR rates. The model assumed 140,000 BCT/year. Sensitivity analyses determined the most cost-effective strategy. Surgical costs were estimated using 2013 Medicare reimbursement rates.Results: Re-excising close margins was significantly more costly than the alternative, $233.1 million versus $214.3 million, per year in the United States. Total surgical cost was most sensitive to re-excision of close margins-increasing the RER from 0% to 100% resulted in an $18.8 million cost difference.Conclusions: The strategy of re-excising close margins resulted in a predicted cost of $18.8 million per year. This does not include hospital costs, the cost of surgical complications after re-excision, and underestimates the potential savings by using Medicare reimbursement rates. (c) 2015 Wiley Periodicals, Inc.