Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction

BACKGROUND: Breast conservation surgery (BCS), consisting of lumpectomy, ax illary lymph node dissection, and radiation therapy, is as effective as mod ified radical mastectomy (MRM) for the treatment of early stage breast canc er. The costs of these treatment options have not been adequately addressed in the current era of increasing utilization of BCS and breast reconstruct ion. The purpose of this study is to determine differences in treatment cos ts among BCS, MRM alone, and MRM with reconstruction. METHODS: Patients with stage I and II breast cancer receiving inpatient tre atment at a private university-affiliated hospital between January 1996 and July 1997 were analyzed (n = 230). Charges were determined as follows: inp atient and radiotherapy charges from the hospital billing department, surge on fees from group practice billing codes, and radiotherapy physician fees from the radiation oncology group practice. Inpatient length of stay was ob tained from hospital medical records. RESULTS: Average hospital inpatient charge for BCS was $4,748 (n = 74), $6, 280 for MRM alone (P < 0.001, n = 132), and $11,946 for MRM with reconstruc tion (P < 0.001, n = 24). Surgeons' fees for BCS were $2,840, $3,500 for MR M alone, and $10,774 for MRM with reconstruction. The average radiotherapy charge was $18,742. Average length of stay was 1.03 days for BCS, 2.44 days for MRM alone (P < 0.001), and 3.71 days for MRM with reconstruction (P < 0.001). Average total cost of BCS ($26,330) was significantly greater than the average total cost of either MRM alone ($9,780, P < 0.001) or MRM with reconstruction ($22,720, P < 0.001). CONCLUSIONS: BCS is more expensive than MRM with or without reconstruction. It is the addition of radiotherapy that results in the higher total cost o f CS. (C) 2000 by Excerpta Medica.