Cost effectiveness of bilateral risk-reducing mastectomy and salpingo-oophorectomy.
BRCA
Breast cancer
Cost effectiveness
Genetic counseling
Ovarian cancer
Journal
European journal of medical research
ISSN: 2047-783X
Titre abrégé: Eur J Med Res
Pays: England
ID NLM: 9517857
Informations de publication
Date de publication:
14 Sep 2019
14 Sep 2019
Historique:
received:
26
05
2019
accepted:
03
09
2019
entrez:
16
9
2019
pubmed:
16
9
2019
medline:
12
5
2020
Statut:
epublish
Résumé
Growing demand for risk-reducing surgery in individuals with inherited susceptibility to cancer leads to the question whether these procedures are cost effective for the executing hospitals. This study compared the clinical costs for bilateral risk-reducing mastectomy (BRRM) with and without different types of reconstruction, risk-reducing salpingo-oophorectomy (RRSO), and their combinations with corresponding reimbursements in the statutory health-care system in Germany. Real total costs of care for BRRM with and without reconstruction, RRSO, and their combinations were calculated as the sum of all personnel and technical costs. These costs calculated in a German University hospital were compared with the sum of all reimbursements in the German DRG-based health-care system. While sole RRSO, BRRM without reconstruction, and BRRM with secondary DIEP (deep inferior epigastric perforator)-reconstruction still result in a small benefit, we even found shortfalls for the hospital with all other prophylactic operations under consideration. The calculated deficits were especially high for BRRM with implant-based breast reconstruction and for combined operations when the risk reduction is achieved with a minimum of separate operations. Risk-reducing surgery in BRCA-mutation carriers is frequently not cost-covering for the executing hospitals in the German health-care system. Thus, appropriate concepts are required to ensure a nationwide care.
Sections du résumé
BACKGROUND
BACKGROUND
Growing demand for risk-reducing surgery in individuals with inherited susceptibility to cancer leads to the question whether these procedures are cost effective for the executing hospitals. This study compared the clinical costs for bilateral risk-reducing mastectomy (BRRM) with and without different types of reconstruction, risk-reducing salpingo-oophorectomy (RRSO), and their combinations with corresponding reimbursements in the statutory health-care system in Germany.
PATIENTS AND METHODS
METHODS
Real total costs of care for BRRM with and without reconstruction, RRSO, and their combinations were calculated as the sum of all personnel and technical costs. These costs calculated in a German University hospital were compared with the sum of all reimbursements in the German DRG-based health-care system.
RESULTS
RESULTS
While sole RRSO, BRRM without reconstruction, and BRRM with secondary DIEP (deep inferior epigastric perforator)-reconstruction still result in a small benefit, we even found shortfalls for the hospital with all other prophylactic operations under consideration. The calculated deficits were especially high for BRRM with implant-based breast reconstruction and for combined operations when the risk reduction is achieved with a minimum of separate operations.
CONCLUSIONS
CONCLUSIONS
Risk-reducing surgery in BRCA-mutation carriers is frequently not cost-covering for the executing hospitals in the German health-care system. Thus, appropriate concepts are required to ensure a nationwide care.
Identifiants
pubmed: 31521205
doi: 10.1186/s40001-019-0391-8
pii: 10.1186/s40001-019-0391-8
pmc: PMC6744699
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32Références
J Clin Oncol. 1999 Feb;17(2):494-500
pubmed: 10080590
J Natl Cancer Inst. 1999 Jun 2;91(11):943-9
pubmed: 10359546
N Engl J Med. 2001 Jul 19;345(3):159-64
pubmed: 11463009
Lancet. 2002 Apr 27;359(9316):1471-7
pubmed: 11988246
Am J Hum Genet. 2003 May;72(5):1117-30
pubmed: 12677558
J Clin Oncol. 2004 Mar 15;22(6):1055-62
pubmed: 14981104
Ann Plast Surg. 2010 May;64(5):684-7
pubmed: 20395792
Breast Cancer Res Treat. 2011 Feb;125(3):837-47
pubmed: 20644999
JAMA. 2010 Sep 1;304(9):967-75
pubmed: 20810374
Dtsch Arztebl Int. 2011 May;108(19):323-30
pubmed: 21637635
Science. 1990 Dec 21;250(4988):1684-9
pubmed: 2270482
J Natl Cancer Inst. 2013 Jun 5;105(11):812-22
pubmed: 23628597
Ann Plast Surg. 2015 Nov;75(5):534-8
pubmed: 24691318
Geburtshilfe Frauenheilkd. 2013 Dec;73(12):1228-1235
pubmed: 24771903
Ann Surg Oncol. 2014 Sep;21(9):2823-30
pubmed: 24809301
Breast Care (Basel). 2014 Dec;9(6):385-9
pubmed: 25759620
Geburtshilfe Frauenheilkd. 2015 Jul;75(7):683-691
pubmed: 26257405
Eur J Surg Oncol. 2016 Jan;42(1):45-50
pubmed: 26553958
Geburtshilfe Frauenheilkd. 2012 Sep;72(9):833-839
pubmed: 26640291
Plast Reconstr Surg. 2016 Sep;138(3):537-47
pubmed: 27556599
J Plast Reconstr Aesthet Surg. 2016 Nov;69(11):1469-1477
pubmed: 27639422
Breast. 2017 Feb;31:224-232
pubmed: 27931006
Breast. 2017 Apr;32:186-191
pubmed: 28214786
Geburtshilfe Frauenheilkd. 2017 Feb;77(2):169-175
pubmed: 28331239
J Clin Oncol. 2017 Aug 1;35(22):2499-2506
pubmed: 28346808
Eur J Health Econ. 2018 Apr;19(3):341-353
pubmed: 28382503
Geburtshilfe Frauenheilkd. 2017 Jun;77(6):651-659
pubmed: 28757652
Geburtshilfe Frauenheilkd. 2017 Aug;77(8):879-886
pubmed: 28845052
Breast Cancer. 2018 Mar;25(2):141-150
pubmed: 29019095
Geburtshilfe Frauenheilkd. 2017 Oct;77(10):1079-1087
pubmed: 29093601
J Natl Cancer Inst. 2018 Jul 1;110(7):714-725
pubmed: 29361001
Geburtshilfe Frauenheilkd. 2018 May;78(5):481-492
pubmed: 29880983
Biomedica. 2018 Sep 01;38(3):363-378
pubmed: 30335242
Geburtshilfe Frauenheilkd. 2018 Oct;78(10):927-948
pubmed: 30369626
Geburtshilfe Frauenheilkd. 2018 Nov;78(11):1110-1118
pubmed: 30498278