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Abstract

Background: Rates of contralateral prophylactic mastectomy in women with unilateral breast cancer continue to rise, especially in women undergoing immediate breast reconstruction (IBR). Methods: We utilized administrative claims data from a large U.S. commercial insurance database (OptumLabs) to identify women age 18+ years who underwent IBR 1/2004-12/2013. We compared 2-year total costs of care and unadjusted utilization rates between unilateral mastectomy (UM) and bilateral mastectomy (BM) for implant-based and autologous reconstruction. Comparisons were tested using t-test and differences in cost were estimated with Wilcoxon rank sum test. Results: 11,728 women undergoing mastectomy with IBR were identified; 7,693 with implant reconstruction (2,090, 27% UM and 5,603, 73% BM) and 4,035 with autologous reconstruction (1,754, 43% UM and 2,281, 57% BM). Mean hospital length of stay at initial surgery and overall rate of office visits was similar between BM+IBR and UM+IBR, however rate of A&E visits was higher for BM+IBR (34.2 per 100 women vs. 30.2, p<0.0001). For implant reconstruction total 2-year cost of care was higher for BM+IBR than UM+IBR for commercial insurance ($106,469 vs. $96,689, p<0.001) however it was not significantly different for medicare advantage. For autologous reconstruction, total medicare advantage 2-year cost of care was higher for BM+IBR ($57,602 vs $37,713, p=0.027) with even greater differences seen in commercial insurance. Conclusion: BM+IBR (autologous or implant) was associated with increased A and E visits and higher total cost of care over 2-years compared to UM+IBR. Patients considering contralateral prophylactic mastectomy should be counseled on the additional risks and costs associated with BM+IBR.

Biography

Email: Boughey.Judy@mayo.edu