Reoperation Costs in Attempted Breast-Conserving Surgery: A Decision Analysis

Background: Breast-conserving surgery (BCS) is the preferred surgical approach for most patients with early-stage breast cancer. Frequently, concerns arise about the pathologic margin status, resulting in an average reoperation rate of 23% in Canada. No consensus has been reached about the ideal reoperation rate, although 10% has been suggested as a target. Upon undergoing reoperation, many patients choose mastectomy and breast reconstruction, which add to the morbidity and cost of patient care. We attempted to identify the cost of reoperation after BCS, and the effect that a reduction in the reoperation rate could have on the B.C. health care system. Methods: A decision tree was constructed to estimate the average cost per patient undergoing initial BCS with two reoperation frequency scenarios: 23% and 10%. The model included the direct medical costs from the perspective of the B.C. health care system for the most common surgical treatment options, including breast reconstruction and postoperative radiation therapy. Results: Costs ranged from a low of $8,225 per patient with definitive BCS [95% confidence interval (CI): $8,061 to $8,383] to a high of $26,026 for reoperation with mastectomy and delayed reconstruction (95% CI: $23,991 to $28,122). If the reoperation rate could be reduced to 10%, the average saving would be $1,055 per patient undergoing attempted BCS (95% CI: $959 to $1,156). If the lower rate were to be achieved in British Columbia, it would translate into a savings of $1.9 million annually. Summary: The implementation of initiatives to reduce reoperation after BCS could result in significant savings to the health care system, while potentially improving the quality of patient care.