Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins

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Abstract

Background: Negative margins are associated with decreased local recurrence after lumpectomy for breast cancer. A 2nd operation for re-excision of positive margins is required with rates varying from 15 to 50%. At our institution we routinely use frozen-section analysis of all margins to minimize rates of 2nd operations. The aim of this study was to evaluate the cost/benefit of routine frozensection analysis. Methods: A decision tree was built to compare 2 strategies: (A) lumpectomy without frozen section and a 2nd operation for positive margin(s) versus (B) lumpectomy with intraoperative frozen-section analysis and a 2nd operation for positive margin(s). For strategy A the rate of positive margins and reoperation were varied from 15 to 50%. For strategy B, a 2nd operation rate of 3% was used. Review of our institutional experience demonstrates an intraoperative re-excision of at least 1 margin in 57% of cases performed with frozen-section support. Results: The cost to provider (i.e., institution) per patient resected to negative margins for strategy A ranged from $4835 to $6306. Average weighted cost of strategy B was $5708. Strategy B was less expensive when the reoperation rate was above 36%. The cost to payor (i.e., Medicare) for strategy A ranged from $3577 to $4665. Average weighted cost for strategy B was $3913. Strategy B was less expensive when the re-excision rate was above 26%. Conclusion: Routine use of frozen-section analysis of lumpectomy margins decreases reoperation rates for margin control; therefore, the cost to provider and payor can be cost effective.

Original languageEnglish (US)
Pages (from-to)3204-3209
Number of pages6
JournalAnnals of Surgical Oncology
Volume18
Issue number11
DOIs
StatePublished - Oct 2011

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Frozen Sections
Reoperation
Cost-Benefit Analysis
Breast
Segmental Mastectomy
Costs and Cost Analysis
Decision Trees
Medicare
Breast Neoplasms
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{c140bce6c4504559bd9c06d677d53a0a,
title = "Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins",
abstract = "Background: Negative margins are associated with decreased local recurrence after lumpectomy for breast cancer. A 2nd operation for re-excision of positive margins is required with rates varying from 15 to 50{\%}. At our institution we routinely use frozen-section analysis of all margins to minimize rates of 2nd operations. The aim of this study was to evaluate the cost/benefit of routine frozensection analysis. Methods: A decision tree was built to compare 2 strategies: (A) lumpectomy without frozen section and a 2nd operation for positive margin(s) versus (B) lumpectomy with intraoperative frozen-section analysis and a 2nd operation for positive margin(s). For strategy A the rate of positive margins and reoperation were varied from 15 to 50{\%}. For strategy B, a 2nd operation rate of 3{\%} was used. Review of our institutional experience demonstrates an intraoperative re-excision of at least 1 margin in 57{\%} of cases performed with frozen-section support. Results: The cost to provider (i.e., institution) per patient resected to negative margins for strategy A ranged from $4835 to $6306. Average weighted cost of strategy B was $5708. Strategy B was less expensive when the reoperation rate was above 36{\%}. The cost to payor (i.e., Medicare) for strategy A ranged from $3577 to $4665. Average weighted cost for strategy B was $3913. Strategy B was less expensive when the re-excision rate was above 26{\%}. Conclusion: Routine use of frozen-section analysis of lumpectomy margins decreases reoperation rates for margin control; therefore, the cost to provider and payor can be cost effective.",
author = "Osborn, {John B.} and Gary Keeney and Jakub, {James W} and Degnim, {Amy C} and Boughey, {Judy C}",
year = "2011",
month = "10",
doi = "10.1245/s10434-011-1956-0",
language = "English (US)",
volume = "18",
pages = "3204--3209",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
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number = "11",

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T1 - Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins

AU - Osborn, John B.

AU - Keeney, Gary

AU - Jakub, James W

AU - Degnim, Amy C

AU - Boughey, Judy C

PY - 2011/10

Y1 - 2011/10

N2 - Background: Negative margins are associated with decreased local recurrence after lumpectomy for breast cancer. A 2nd operation for re-excision of positive margins is required with rates varying from 15 to 50%. At our institution we routinely use frozen-section analysis of all margins to minimize rates of 2nd operations. The aim of this study was to evaluate the cost/benefit of routine frozensection analysis. Methods: A decision tree was built to compare 2 strategies: (A) lumpectomy without frozen section and a 2nd operation for positive margin(s) versus (B) lumpectomy with intraoperative frozen-section analysis and a 2nd operation for positive margin(s). For strategy A the rate of positive margins and reoperation were varied from 15 to 50%. For strategy B, a 2nd operation rate of 3% was used. Review of our institutional experience demonstrates an intraoperative re-excision of at least 1 margin in 57% of cases performed with frozen-section support. Results: The cost to provider (i.e., institution) per patient resected to negative margins for strategy A ranged from $4835 to $6306. Average weighted cost of strategy B was $5708. Strategy B was less expensive when the reoperation rate was above 36%. The cost to payor (i.e., Medicare) for strategy A ranged from $3577 to $4665. Average weighted cost for strategy B was $3913. Strategy B was less expensive when the re-excision rate was above 26%. Conclusion: Routine use of frozen-section analysis of lumpectomy margins decreases reoperation rates for margin control; therefore, the cost to provider and payor can be cost effective.

AB - Background: Negative margins are associated with decreased local recurrence after lumpectomy for breast cancer. A 2nd operation for re-excision of positive margins is required with rates varying from 15 to 50%. At our institution we routinely use frozen-section analysis of all margins to minimize rates of 2nd operations. The aim of this study was to evaluate the cost/benefit of routine frozensection analysis. Methods: A decision tree was built to compare 2 strategies: (A) lumpectomy without frozen section and a 2nd operation for positive margin(s) versus (B) lumpectomy with intraoperative frozen-section analysis and a 2nd operation for positive margin(s). For strategy A the rate of positive margins and reoperation were varied from 15 to 50%. For strategy B, a 2nd operation rate of 3% was used. Review of our institutional experience demonstrates an intraoperative re-excision of at least 1 margin in 57% of cases performed with frozen-section support. Results: The cost to provider (i.e., institution) per patient resected to negative margins for strategy A ranged from $4835 to $6306. Average weighted cost of strategy B was $5708. Strategy B was less expensive when the reoperation rate was above 36%. The cost to payor (i.e., Medicare) for strategy A ranged from $3577 to $4665. Average weighted cost for strategy B was $3913. Strategy B was less expensive when the re-excision rate was above 26%. Conclusion: Routine use of frozen-section analysis of lumpectomy margins decreases reoperation rates for margin control; therefore, the cost to provider and payor can be cost effective.

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