Costs of Breast Surgery Reconstruction and Mastectomy in France between 2019 and 2021

Author(s)

Da Deppo L1, Benyahi D2, Hiridjee S3, Schmidt A4, Mihailescu O4
1Integra Lifesciences, Basiglio (Milano), MI, Italy, 2Consultant Plastic surgeon, Paris, Île-de-France, France, 3Heva, Lyon, Rhône, France, 4Heva, Lyon, France

OBJECTIVES: To describe the costs associated with hospital stays for breast reconstruction and mastectomy compared to current hospital DRG tariffs in France.

METHODS: An observational retrospective study was conducted using the French National Hospital Database (PMSI). Adult (≥18) patients with at least one hospital stay for mastectomy or breast reconstruction surgery between 2019 and 2021 were included, identified via specific medical classification for clinical procedure (CCAM) codes. The 10 most frequently associated DRGs were described in terms of costs.

RESULTS: Over the study period, 76 896 patients had at least one stay for mastectomy or breast reconstruction. The most frequent DRG identified was Ambulatory breast procedures for non-malignant conditions other than biopsy and local excision procedures (09C06T), followed by Cosmetic surgery without complications (09Z02A) and Major surgery excluding malignant breast tumor, level 1 (09C221). These 3 DRGs accounted for 56.2% (N = 43 189 patients) of the study population.

The costs for DRG 09Z02A could not be estimated as cosmetic surgery is not reimbursed by Social Security. The mean reimbursed costs per patient were 2 287€ for DRG 09C06T and 2 459€ for DRG 09C211, whereas the average tariffs were 1 865€ and 2 167€ respectively. The difference was mostly due to the use of advanced treatments and medical devices in addition to the intra-DRG tariff , averaging at 158€ and 309€ extra costs per patient respectively. The use of implants and dermal substitutes could not be identified as these devices are not reimbursed by Social Security.

The other 7 DRGs identified will be presented in the poster.

CONCLUSIONS: The majority of tariffs for mastectomy or breast reconstruction cover the costs of the surgical procedure in ambulatory or level 1 stays, however the cost related to the use of advanced medical devices are likely to be underestimated.

Conference/Value in Health Info

2023-11, ISPOR Europe 2023, Copenhagen, Denmark

Value in Health, Volume 26, Issue 11, S2 (December 2023)

Code

EE741

Topic

Economic Evaluation, Health Policy & Regulatory

Topic Subcategory

Public Spending & National Health Expenditures

Disease

Surgery

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