Observation interval for evaluating the costs of surgical interventions for older women with a new diagnosis of breast cancer

Med Care. 2001 Nov;39(11):1146-57. doi: 10.1097/00005650-200111000-00002.


Objective: To estimate the episodic costs of surgical treatments for breast cancer.

Methods: The surgical treatment period as the 6 weeks following diagnosis is defined. Using a sample of 205 women aged 65 and older and their Medicare claim files, the cost of treatment is estimated and the progression from first to subsequent surgical procedures during the 6-week interval is demonstrated with a decision tree. Two equations are then estimated: the probability of mastectomy versus breast conserving surgery (BCS) as first surgery using Probit regression and the log of total charges using a generalized linear regression model.

Results: It was found that only stage predicts the probability of mastectomy versus BCS and that 54% of women receiving BCS undergo a second surgery. Once all treatments in the initial surgical period are accounted, the difference between the adjusted cost of mastectomy alone and BCS followed by a second surgery was not statistically significant. Only a successful first BCS is statistically significantly (P <0.05) less costly than a mastectomy alone ($4,955 vs. $9,049).

Conclusions: By defining a 6-week surgical treatment episode it is shown that BCS followed by subsequent surgeries is the more costly option for initial treatment. Given the high prevalence of second surgeries, previous work may have underestimated the costs of surgical interventions for breast cancer.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / surgery*
  • Cost-Benefit Analysis
  • Decision Trees
  • Episode of Care
  • Female
  • Health Care Costs*
  • Hospital Charges
  • Humans
  • Likelihood Functions
  • Mastectomy, Radical / economics*
  • Mastectomy, Radical / statistics & numerical data
  • Mastectomy, Segmental / economics*
  • Mastectomy, Segmental / statistics & numerical data
  • Medicare
  • Regression Analysis
  • Reoperation / economics
  • Reoperation / statistics & numerical data
  • United States