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Prophylactic mastectomy may be cost effective compared with surveillance

Contralateral or bilateral prophylactic mastectomy may be cost saving in lifetime third-party costs for patients recently diagnosed with unilateral breast cancer and for BRCA gene carriers, according to study results.

Researchers used 2013 Medicare reimbursement rates to estimate lifetime third party payer costs over 30 years. They estimated costs for patients recently diagnosed with unilateral breast cancer choosing contralateral prophylactic mastectomy, and for BRCA gene carriers choosing bilateral prophylactic mastectomy vs. surveillance.

Immediate reconstructions used a single-stage implant, tissue expander or perforator-based free flap.

Percentage of patients using surveillance requiring mastectomies was predicted through published cancer incidence rates. Lifetime costs and present values (using an annual 3% discount rate) were calculated.

“Lifetime prophylactic mastectomy costs were lower than surveillance costs, $1292 to $1993 lower for contralateral prophylactic mastectomy and $15,668 to $21,342 lower for bilateral prophylactic mastectomy, depending on the reconstruction,” the researchers wrote.

Contralateral prophylactic mastectomy had slightly higher present value estimates compared with contralateral surveillance; however, bilateral prophylactic mastectomy had cost savings in present value estimates compared with bilateral surveillance.

When the modeled contralateral breast cancer incidence rate was increased to at least 0.6% per year, present value estimates were cost saving for contralateral prophylactic mastectomy.

“Patients increasingly seek more proactive ways of reducing their risk of breast cancer,” the researchers wrote.

“This study’s results support continuing to give patients the flexibility to opt for contralateral and bilateral prophylactic mastectomy and the flexibility to choose the reconstruction option that best fits their needs,” the researchers concluded. “We believe that governments and other third-party payers should continue to cover these options for patients and clinicians, as this study suggests that prophylactic mastectomy may even be cost-saving vs. surveillance, and therefore does not increase the fiscal burden of health care.” – by Bruce Thiel

Disclosure: Mattos reports no relevant financial disclosures. Please see the full study for a list of other researchers’ relevant financial disclosures.