Purpose: Ablative options, beyond mastectomy, for large breasted patients with
breast cancer include oncoplastic resection via reduction pattern and standard
lumpectomy. Oncoplastic resection also entails a contralateral procedure for
symmetry and the potential benefit of a superior cosmetic outcome. Our aim was
to examine the cost-effectiveness of this treatment strategy comparing it to
standard lumpectomy in treating breast cancer patients. Methods: A
literature review was performed of the probabilities and outcomes related to
treatment of unilateral breast cancer via oncoplastic resection or unilateral
lumpectomy. Utility score surveys were used to estimate the quality adjusted
life years (QALYs) associated with a successful procedure, additional margins
excision and post-operative complications. A decision analysis tree was
developed to highlight the more cost-effective strategy. An Incremental
Cost-Utility Ratio (ICUR) was calculated. Sensitivity analysis was performed to
check the robustness of our data. Results: Oncoplastic resection was
associated with fewer positive margins relative to standard lumpectomy (10.0%
versus 18%). In cases with positive margins, a greater percentage of
oncoplastic resection patients chose a mastectomy compared to the lumpectomy
patients (72% versus 19%). Utility scores for a successful operation favored
oncoplastic resection (92.6 versus 86.55), but in instances of positive
margins, favored the lumpectomy patients (74.2 versus 70.2). Decision tree
analysis revealed that oncoplastic resection was more cost-effective with an
ICUR of $2609.66/QALY gained. Conclusion: Oncoplastic resection represents
a cost-effective strategy for the large breasted patient and provides the
surgical team yet another reasonable option for the appropriate patient.
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