Background: The aim was to evaluate the cost-utility of four common surgical treatment pathways for breast cancer: mastectomy, breast-conserving therapy (BCT), implant breast reconstruction (BR) and autologous-BR. Methods: Patient-level healthcare consumption data and results of a large quality of life (QoL) study from five Dutch hospitals were combined. The cost-effectiveness was assessed in terms of incremental costs and quality adjusted life years (QALYs) over a 10-year follow-up period. Costs were assessed from a healthcare provider perspective. Results: BCT resulted in comparable QoL with lower costs compared to implant-BR and autologous-BR and showed better QoL with higher costs than mastectomy (€17,246/QALY). QoL outcomes and costs of especially autologous-BR were affected by the relatively high occurrence of complications. If reconstruction following mastectomy was performed, implant-BR was more cost-effective than autologous-BR. Conclusion: The occurrence of complications had a substantial effect on costs and QoL outcomes of different surgical pathways for breast cancer. When this was taken into account, BCT was most the cost-effective treatment. Even with higher costs and a higher risk of complications, implant-BR and autologous-BR remained cost-effective over mastectomy. This pleas for adapting surgical pathways to individual patient preferences in the trade-off between the risks of complications and expected outcomes.

Breast neoplasms, Cost-benefit analysis, Eq-5d, Mammaplasty, Quality of life, Quality-adjusted life years, Surgical oncology
dx.doi.org/10.1016/j.ejso.2020.11.130, hdl.handle.net/1765/132881
European Journal of Surgical Oncology

Kouwenberg, C.A.E, Mureau, M.A.M, Kranenburg, L.W, Rakhorst, H.A, de Leeuw, D. (Daniëlle), Klem, T.M.A.L, … van Busschbach, J.J. (2020). Cost-utility analysis of four common surgical treatment pathways for breast cancer. European Journal of Surgical Oncology. doi:10.1016/j.ejso.2020.11.130