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Patient-level costs in margin re-excision for breast-conserving surgery

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Title: Patient-level costs in margin re-excision for breast-conserving surgery
Authors: Grant, Y
Al-Khudairi, R
St John, E
Barschkett, M
Cunningham, D
Al-Mufti, R
Hogben, K
Thiruchelvam, P
Hadjiminas, DJ
Darzi, A
Carter, AW
Leff, DR
Item Type: Journal Article
Abstract: Background High rates of reoperation following breast‐conserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported re‐excision costs and compare the direct patient‐level costs between patients undergoing successful BCS versus reoperations after BCS. Methods The study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the Patient‐Level Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = £0·75, £1 = €1·14 and US $1 = €0·85. Results The median QHES score was 47 (i.q.r. 32·5–79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US $1234–11786 and $655–9136 respectively. Over a 12‐month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was £4511 (range 1752–18 019), representing an additional £2136 per patient compared with BCS without reoperation (P < 0·001). Conclusion The systematic review demonstrated variation in methodological approach to cost estimates and a paucity of high‐quality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.
Issue Date: 27-Feb-2019
Date of Acceptance: 6-Oct-2018
URI: http://hdl.handle.net/10044/1/72671
DOI: https://doi.org/10.1002/bjs.11050
ISSN: 1365-2168
Publisher: Wiley
Start Page: 384
End Page: 394
Journal / Book Title: British Journal of Surgery
Volume: 106
Issue: 4
Copyright Statement: © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd. This is the accepted version of the following article: Grant, Y. , Al‐Khudairi, R. , St John, E. , Barschkett, M. , Cunningham, D. , Al‐Mufti, R. , Hogben, K. , Thiruchelvam, P. , Hadjiminas, D. J., Darzi, A. , Carter, A. W. and Leff, D. R. (2019), Patient‐level costs in margin re‐excision for breast‐conserving surgery. Br J Surg, 106: 384-394, which has been published in final form at https://doi.org/10.1002/bjs.11050
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
National Institute of Health Research
Funder's Grant Number: RDB04
RDB04
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
20-YEAR FOLLOW-UP
LOCAL RECURRENCE
CANCER
MASTECTOMY
THERAPY
WOMEN
TRIAL
LUMPECTOMY
PATHOLOGY
RATES
Science & Technology
Life Sciences & Biomedicine
Oncology
Surgery
Science & Technology
Life Sciences & Biomedicine
Surgery
20-YEAR FOLLOW-UP
LOCAL RECURRENCE
CANCER
MASTECTOMY
THERAPY
WOMEN
TRIAL
LUMPECTOMY
PATHOLOGY
RATES
11 Medical and Health Sciences
Surgery
Publication Status: Published
Online Publication Date: 2018-12-19
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation