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Margin re‐excision and local recurrence in invasive breast cancer: A cost analysis using a decision tree model
Author(s) -
Abe Shoko E.,
Hill Joshua S.,
Han Yimei,
Walsh Kendall,
Symanowski James T.,
HadzikadicGusic Lejla,
FlippoMorton Teresa,
Sarantou Terry,
Forster Meghan,
White Richard L.
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23990
Subject(s) - medicine , reimbursement , margin (machine learning) , breast cancer , surgical margin , surgery , cost analysis , cancer , general surgery , health care , resection , operations research , machine learning , computer science , engineering , economics , economic growth
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 A decision 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) and negative (>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. J. Surg. Oncol. 2015; 112:443–448 . © 2015 Wiley Periodicals, Inc.