Abhishek Chatterjee¹, Anaeze C. Offodile II², Ammar Asban³, Raquel A. Minasian¹, Albert Losken⁴, Roger Graham¹, Lilian Chen¹, Brian J. Czerniecki⁵, Carla Fisher⁶

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¹ Department of Surgery, Tufts University Medical Center, Boston, MA, USA.
² Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
⁵ Department of Breast Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA.
⁶ Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract: Purpose: Ablative options, beyond mastectomy, for large breasted patients with breast cancer include oncoplastic resection via reduction pattern and standard lumpectomy. Oncoplastic resection also entails a contralateral procedure for symmetry and the potential benefit of a superior cosmetic outcome. Our aim was to examine the cost-effectiveness of this treatment strategy comparing it to standard lumpectomy in treating breast cancer patients. Methods: A literature review was performed of the probabilities and outcomes related to treatment of unilateral breast cancer via oncoplastic resection or unilateral lumpectomy. Utility score surveys were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure, additional margins excision and post-operative complications. A decision analysis tree was developed to highlight the more cost-effective strategy. An Incremental Cost-Utility Ratio (ICUR) was calculated. Sensitivity analysis was performed to check the robustness of our data. Results: Oncoplastic resection was associated with fewer positive margins relative to standard lumpectomy (10.0% versus 18%). In cases with positive margins, a greater percentage of oncoplastic resection patients chose a mastectomy compared to the lumpectomy patients (72% versus 19%). Utility scores for a successful operation favored oncoplastic resection (92.6 versus 86.55), but in instances of positive margins, favored the lumpectomy patients (74.2 versus 70.2). Decision tree analysis revealed that oncoplastic resection was more cost-effective with an ICUR of $2609.66/QALY gained. Conclusion: Oncoplastic resection represents a cost-effective strategy for the large breasted patient and provides the surgical team yet another reasonable option for the appropriate patient.

Keywords: Breast Cancer, Lumpectomy, Mastectomy, Cost-Utility Analysis

Cite this paper: Chatterjee, A. , Offodile II, A. , Asban, A. , Minasian, R. , Losken, A. , Graham, R. , Chen, L. , Czerniecki, B. and Fisher, C. (2018) A Cost-Utility Analysis Comparing Oncoplastic Breast Surgery to Standard Lumpectomy in Large Breasted Women. Advances in Breast Cancer Research, 7, 187-200. doi: 10.4236/abcr.2018.72011.

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