Effect of Surgical Choices on the Cost of Breast Cancer Care

OBJECTIVES: To identify cost associated with different surgical procedures for the patients diagnosed with breast cancer.

METHODS: 2016-2021 Medicare Data matched with tumor registries are used for the analysis. We identified major components of breast cancer treatment by examining surgical and adjuvant care options applied to a cohort of women with incident cases of breast cancer. We then estimated total cost of care 1 year following diagnosis. We differentiate between mastectomy alone, single breast conserving surgery (BCS), multiple BCS, BCS followed by mastectomy, and BCS followed by axillary node dissection. We used log-linear regression controlling for age, comorbidity, physical functioning, and disease stage. To retransform the mean costs, we estimated separate smearing factors for surgical therapies.

RESULTS: 64% of our sample were in situ/local, 29% of our sample were in regional and 13% of our sample were in distant stage. As mastectomy alone reference, Single BCS 38% , multiple BCS 64% , BCS followed by mastectomy was 21% higher. Adjuvant regimen increased the costs significantly, in particular, radiation only increased costs 61%, chemotherapy increased the costs 88%, chemotherapy and radiation increased the cost 143%.

CONCLUSIONS: Our analysis revealed both important correlated of cost and unexpected practice patterns. Treatment choices involving BCS were clearly more expensive than mastectomy options because of the high probability of subsequent surgeries and the need for adjuvant care.