Costs of Breast Cancer Surgical Care in Newly Diagnosed Patients in 2015 and 2019: A French Nationwide Claims Database Study
Author(s)
Elsa Bouee Benhamiche, PharmD1, Christine Le Bihan Benjamin, MD1, Claire Morgand, MD, PhD1, Claire Bonneau, MD, PhD2.
1Survey, Monitoring and Assessment Department, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France, 2Department of surgical oncology, Institut Curie, Saint-Cloud, France.
1Survey, Monitoring and Assessment Department, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France, 2Department of surgical oncology, Institut Curie, Saint-Cloud, France.
OBJECTIVES: Breast cancer surgery is the main treatment for nonmetastatic breast cancer, the most frequent cancer in female. Our aim was to estimate the cost of this surgical care and investigate the impact of the development of ambulatory surgery (after 2015) on postoperative costs in France.
METHODS: Adult women newly diagnosed with breast cancer in 2015 or 2019 who underwent a lumpectomy or a mastectomy for breast cancer within 365 days were identified in the French national cancer cohort, including since 2010 all cancer patients from the large French health insurance claims database (SNDS). Costs from the payer's perspective of healthcare resource utilization during the surgery stay and the 30-day postoperative were assessed, as well as out-of-pocket payments (OOP). Univariate cost analyses were performed with non-parametric Wilcoxon test, multivariate cost analyses with generalized linear model (gamma distribution and log link).
RESULTS: Of the 97,793 included patients: 49,977 in 2015 and 47,816 in 2019, 76,672 (78%) underwent a lumpectomy, 21,121 (22%) had a total mastectomy. Between 2015 and 2019, the ambulatory portion rose from 29% to 51% for lumpectomy and from 1% to 5% for mastectomy. Mean reimbursed expenditures per patient were significantly higher for patients with mastectomy than for those with lumpectomy (4,192 vs 2,717 euros, p<0.0001) with a remaining 00P of 6% in both groups (285 and 198 euros respectively). After adjusting for potential confounders (demographic, surgery stay, neoadjuvant therapy, hospital characteristics), incremental cost was estimated at 788 euros (p<0.0001). The multivariate analysis of 30-day postoperative costs showed no significant extra cost in 2019 compared to 2015.
CONCLUSIONS: Our study provides a nationwide estimate of the cost of breast cancer surgery for health insurance and an OOP estimation. Our findings indicate that the development of ambulatory surgery did not lead to a cost shift to the 30-day postoperative period.
METHODS: Adult women newly diagnosed with breast cancer in 2015 or 2019 who underwent a lumpectomy or a mastectomy for breast cancer within 365 days were identified in the French national cancer cohort, including since 2010 all cancer patients from the large French health insurance claims database (SNDS). Costs from the payer's perspective of healthcare resource utilization during the surgery stay and the 30-day postoperative were assessed, as well as out-of-pocket payments (OOP). Univariate cost analyses were performed with non-parametric Wilcoxon test, multivariate cost analyses with generalized linear model (gamma distribution and log link).
RESULTS: Of the 97,793 included patients: 49,977 in 2015 and 47,816 in 2019, 76,672 (78%) underwent a lumpectomy, 21,121 (22%) had a total mastectomy. Between 2015 and 2019, the ambulatory portion rose from 29% to 51% for lumpectomy and from 1% to 5% for mastectomy. Mean reimbursed expenditures per patient were significantly higher for patients with mastectomy than for those with lumpectomy (4,192 vs 2,717 euros, p<0.0001) with a remaining 00P of 6% in both groups (285 and 198 euros respectively). After adjusting for potential confounders (demographic, surgery stay, neoadjuvant therapy, hospital characteristics), incremental cost was estimated at 788 euros (p<0.0001). The multivariate analysis of 30-day postoperative costs showed no significant extra cost in 2019 compared to 2015.
CONCLUSIONS: Our study provides a nationwide estimate of the cost of breast cancer surgery for health insurance and an OOP estimation. Our findings indicate that the development of ambulatory surgery did not lead to a cost shift to the 30-day postoperative period.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE291
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology, Surgery